Professional Documents
Culture Documents
SEMINAR ON :-
INFECTION CONTROL
And
STANDARD SAFETY MEASURES
SUBMITTED BY:
Mr. Shilu M.P
Associate Professor
S.R.M.M.CON,Sawangi (M)
General objective
At the end of class, students will be able to understand and
have knowledge regarding infection control and standard
safety measures and will be able to apply their knowledge in
settings
Specific objective
At the end of the class student will be able
define infection.
discuss the epidermiology of infection.
describe chain of infection.
explain stages of infection.
explain infection control programme and policies.
explain the measures to control of hospital infection.
eneumerate standard safety measures.
explain transimission based precaution.
explain about personal protective equipment.
explain role of nurse in infection control.
INFECTION CONTROL
INTRODUCTION:
Infection involves interaction between the animal body (host) and the injecting
microorganism. Practice or techniques that prevent transmission of infection protect clients and
health care workers from disease. Clients in all health care setting are at risks for acquiring
infections because of lower resistance to infectious microorganisms, increase exposure to
numbers and types of disease and causing microorganisms and invasive procedures.
NATURE OF INFECTION:
An infection is the entry and multiplication of an infectious agent in the tissue of a host.
-
If the infectious agent (pathogen) fails to cause injury to cells or tissues, the
pathogen is colonizing the cells or tissues without causing harm.
If the pathogens multiply and cause clinical signs and symptoms, the infection is
symptomatic.
If the infectious disease can be transmitted directly from one person to another,
it is a communicable or contagious disease.
DEFINITION:
1. According to Baillieres Nurses Dictionary
Infection is the invasion and multiplication of microorganisms in body tissues, specially
that causing local cellular injury due to competitive metabolism, toxins, intracellular
replication or antigen-antibody response.
2. Brunner And Suddarths; 9th Edition; Page no. 1870
Infection is a condition in which the host interacts physiologically and immunologically
with a microorganism.
3. Potter & Perry; 5th Edition; Page no. 149
EPIDEMIOLOGY OF INFECTION:
The occurance and manifestation of any disease whether communicable or noncommunicable are determine by the interactions between the agent, the host and the
environment, which together constitute the epidemiological triad.
Envio
nmen
t
Agen
t
Host
Agent:
The first link in the chain of infection transmission is agent, which is defined as a
substance, living or non living. A disease may have a single agent, a number of independent
alternative agents or a complex of two or more factors whose combine presence is essential for
the development of disease.
Agent may be classified broadly into following groups:
i.
ii.
iii.
iv.
v.
vi.
Chemical agents:
a) Endogenous: some of the chemicals may be produced in the body as a result of
disarrangement of function e.g. serum bilirubin (jaundice), urea (uremia), calcium
carbonate (kidney stones), etc.
b) Exogenous: agent arising outside of human host e.g. fumes, dust, gases, etc.
Mechanical agents: exposure to chronic friction and other mechanical forces may result
in crushing, tearing, dislocation, and even death.
Social agent: poverty, smoking, drug and alcohol abuse, unhealthy lifestyles, social
isolation and maternal deprivation.
Host:
The host is the man itself. In some situation host factors play a major role in determining the
outcome of an individuals exposure to infection. The host factors may be classified as:
i.
ii.
iii.
iv.
Environment:
The environment of man is of two types internal and external.
Internal environment is comprised by the various tissues, organs and organ systems within the
human body.
External environment is defined as all that, which is external to the individual human host.
Generally we study the environment under three headings
Physical
Biological and
Social.
Physical environment: applied to non-living things and physical factors e.g. air, water, soil,
housing, climate, geography, heat, light, noise, radiation, etc.
Biological environment: universe of living things which surrounds man, including man himself.
e.g. viruses, microbial agents, insects, animals and plants.
Psychological environment: e.g. cultural values, customs, habits, beliefs, attitudes, morals,
religion, education, lifestyles, community life, health services.
CHAIN OF INFECTION:
The presence of a pathogen does not mean that an infection will begin. Development of an
infection occurs in a cycle that depends on the presence of all the following elements:
1. Infectious agent:
The development of an infectious disease depends on the number of organisms present;
their virulence, or ability to produce disease; their ability to enter or survive in the host;
and the susceptibility of the host.
2. Reservoir:
Places where microorganisms can survive, multiply, and await transfer to a susceptible
host are called reservoirs. Common reservoirs are humans and animals (host), insects,
food, water, and organic matter or inanimate surfaces (fomites).
3. Portal of exit:
After microorganisms find a site to grow and multiply, they must find a portal of exit if
they are to enter another host and cause disease. Microorganisms can exit through a
variety of sites such as skin and mucous membranes, respiratory tract, gastrointestinal
tract, reproductive tract, and blood.
4. Mode of transmission:
There are many modes for transmission of microorganisms from the reservoir to the host.
Although the major mode of transmission of microorganisms is the hands of the health
care worker, almost any object within the environment can become a means of
transmitting pathogens.
5. Portal of entry:
Organisms can enter the body through the same route they use for exiting. Common
portals of entry include non intact skin, mucus membranes, genitourinary tract,
gastrointestinal tract and respiratory tract.
6. Susceptible host:
Susceptibility to an infectious agent depends on the individuals degree of resistance to
pathogens. An infection does not develop until an individual becomes susceptible to the
strength and numbers of microorganism capable of producing infection.
STAGES OF INFECTION:
1. Incubation period: It is the time interval between entrance of pathogen into the body and
appearance of first symptoms. (e.g. chicken pox 2-3 weeks; common cold 1-2 days;
influenza 1-3days; mumps 15-18 days).
2. Prodromal stage: Interval from onset of nonspecific signs and symptoms (malaise, lowgrade fever, fatigue) to more specific symptoms.
3. Illness stage: Interval when client manifests signs and symptoms specific to type of
infection.
4. Convalescence: Interval when acute symptoms of infection disappear. Length of
recovery depends on severity of infection and clients general state of health; recovery
may take several days to months.
ii.
Identification:
-
iii.
Prevention:
-
iv.
The agency collects data about infections to detect any changes in infection
trends. Targeted surveillance, which focuses on specific patient populations
and / or specific procedures, is tracked on an annual basis.
Reporting:
-
Patient and staff infections are reported internally and externally, as required by
law.
3. The basic components of the agencys infection control program include the following:
i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
ix.
4. The design, data collection, and assessment of the infection control program is completed
by the quality improvement (QI) staff as a component of the QI program. Infection control
policies and procedures are reviewed and updated as needed, but are formally reviewed by
the QI staff and the Director of Clinical Services on an annual basis.
5. Education of home care staff in infection control and isolation precaution is required at
orientation and annually. At a minimum, this education should include:
-
Hand washing
Personal hygiene
Employee health infection control issues
Transmission of infection
Care of patients with communicable diseases.
Standard precautions and blood borne pathogens
Disposal of infectious waste and sharps.
Appropriate cleaning issues.
Principles of asepsis.
Personal protective equipment.
CONTROL MEASURES:
A. General measures:
a) Personal hygiene and environmental sanitation kept at high level in the hospital of any
kind, is mandatory requirement towards control of hospital infection.
b) Efficient house keeping including clean supply of bed linen and patients dress, proper bed
arrangement; frequent mopping and periodic washing of hospital wards and department
floors.
c) Provision of ancillary facilities like:
i. CSSD Facilities for standard sterilization of all hospital supplies e.g.
syringe, needles, surgical instruments, O.T. linen, sets of trays for
diagnostic and therapeutic purpose, rubber goods and other
requirements.
ii. Mechanical laundry in referral institutional hospitals and larger
hospitals will endure clean and adequate linen sully to patients and
reduce infections.
iii.
Food-ordering, procurement, preparation and distribution must be
arranged through organized kitchen service.
Minimum of handling must be ensured. Adequate water supply and
washing facilities of food items and utensils to be made available.
iv. Prompt and coordinated system of waste disposal e.g. dry waste
materials and sewage must be established through incinerators,
underground drainage.
v. Each ward must be provided with isolation facilities in separate rooms
for infectious patients over and the isolation wards.
vi. In small hospitals procedure manuals for workers to be provided for
strict compliance.
B. Special control measures:
i.
ii.
iii.
iv.
Pediatric ward:
- 4-6 bedded ward facilities with provision of isolation.
- Similar age-group patients in one room.
- Strict aseptic procedure to be ensured.
- Nursing staff must ensure strict personal hygiene and hand washing.
- Minimum attendants.
- Prompt removal of any attendant with infection.
Nurseries:
- Scrupulous cleanliness and asepsis.
- 4-6 bedded cubicles.
- Visitors are not to be permitted.
- Gowning and use of mask to be encouraged.
- Due care for preparation of feeds and sterilization of bottles and other
accessories.
Maternity Ward:
- Delivery room planning on the line of OT.
- Strict aseptic measures to be followed.
- Facility for isolation should be provided in 4-6 bedded wards.
- Regular floor washing and cleaning.
Other control measures will include infection oriented training to hospital staff to assess
the importance of standards of asepsis, personal hygiene and cleanliness.
Patients, relatives and visitors should be educated by the hospital staff about matters of
infection, isolation, hand washing and other related areas.
HOSPITAL INFECTION CONTROL COMMITTEE:
To control hospital infection, it is essential that the hospital according to its available
resources and requirement establishes a Hospital infection control committee and invest it with
authority to persue:
-
A. Composition:
Surgeon
Physician
Anesthetist
Pediatrician
Bacteriologist
Gynecologists
Nursing matron
House keeping staff
Engineering service representative
Dietician
Microbiologist
In a still smaller hospital situation, the whole responsibility can be given to one Medical
Officer only.
B. Role and function:
i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
ix.
x.
The hospital surveillance programme should be geared to determine the endemic level of
infection and be responsive to any epidemic situation like.
-
Sudden cluster-like increase at any period of time and in a particular hospital area.
Unusual sporadic cases.
Investigating actions.
Confirm diagnosis including bacteriological culture.
Total number of cases established.
Investigations for carrier, common source, break-in technique, vehicle of infection
and any other abnormal situation.
Obtaining cultures from carrier and from vital areas CSD, OTS, Nurseries, etc.
ISOLATION PRECAUTIONS:
Isolation refers to measures designed to prevent the spread of infections or potentially
infectious microorganisms to health personnel, clients, and visitors. A variety of infection control
measures are used to decrease the risk of transmission of microorganisms in hospitals.
CDC Isolation Precautions (1983 and 1987):
In 1983 the Centres for Disease Control and Prevention (CDC) established isolation
guidelines that allowed health facilities to choose between two systems: category specific or
disease specific isolation.
Category specific isolation precautions are based on seven categories: strict isolation,
contact isolation, respiratory isolation, tuberculosis isolation, enteric precautions, drainage /
secretion precautions, and blood / body fluid precautions.
Disease specific isolation precautions provide precautions for specific diseases.
For example, pulmonary tuberculosis precautions specify putting the client in a private room
with special ventilation or having the client share a room with other clients who are infected with
the same organism and the use of masks for nurses entering the room and gowning only to
prevent gross soilage of clothes.
Universal precautions (CDC 1987):
1) Wear masks and protective eyewear or face shields in situations where droplets of blood
or other body fluids may spray onto the mucus membranes of the eyes, nose, or mouth.
2) Wear gloves when in contact with blood or other body fluids containing blood and when
handling supplies and equipment or surfaces soiled with blood or other body fluids.
Change gloves after client contact.
3) Wear gown in situations where it is likely that droplets of blood or body fluids will be
sprayed.
4) Immediately and thoroughly wash hands or other skin surfaces that come into contact
with blood or other body fluids.
5) To prevent needle stick injuries, deposit used needles in a puncture-resistant container
that has a secure lid and has been placed near the area where the needles were used. Do
not recap, break, or bend needles after use.
6) Use mouth pieces, resuscitation bags, or other ventilation equipment when providing
resuscitation. This reduces the need for mouth-to-mouth contact.
7) Do not provide direct client care when you have open or exudative skin lesions.
Body Substance Isolation (BSI) System (1991):
Body Substance Isolation (BSI) employs generic infection control precautions for all
clients except those with the few diseases transmitted through the air.
The main elements of BSI are:
1) Wash hands thoroughly before and after client care and when gloves are removed.
2) Wear clean gloves before contact with any body fluids, mucus membranes, non intact
skin, and any moist areas.
3) Wear gowns, plastic aprons, masks, protective eyewear, hair covers, and shoe covers are
required to keep moist body substances off clothing, skin, hair, and mucus membranes.
4) Discard all needles and sharp instruments in a puncture-proof container at the place of
use.
5) Bag soiled linen securely before it is transported to the laundry area.
6) Place disposable trash in plastic bags and dispose off it according to agency protocol.
7) Handling and reprocessing practices are the same for all equipment used on all clients.
8) Place all specimens in plastic bags, seal the bags, and arrange for transport to the
laboratory.
CDC (HICPAC) Isolation precautions (1997):
The Hospital Infection Control Practices Advisory Committee (HICPAC) of the CDC
presented new guidelines for isolation precautions in hospital. These latest guidelines designate
two tiers of precautions:
Tier 1: Standard precautions
Tier 2: Transmission Based Precautions.
2. Wear clean gloves when touching blood, body fluids, secretions, excretions and
contaminated items.
3. Wear a mask, eye protection, or a face shield if splashes or sprays of blood, body fluids,
secretions, or excretions can be expected.
4. Wear a clean, nonsterile gown if client case is likely to result in splashes or sprays of
blood, body fluids, secretions or excretions.
5. Handle client care equipment that is soiled with blood, body fluids, secretions or
excretions carefully to prevent the transfer of microorganisms to others and to the
environment.
6. Handle transport and process linen that is soiled with blood, body fluids, secretions, or
excretions in a manner to prevent contamination of clothing and the transfer of
microorganisms to others and to the environment.
7. Prevent injuries from used equipment, i.e. scalpels or needles, and place in punctureresistant containers.
Transmission-Based Precautions:
Airborne precautions:
1. Place client in a private room that has negative air pressure; 6 to 12 air changes per hour
and discharge of air to the outside or a filtration system for the room air.
2. If a private room is not available, place client with another client who is infected with the
same microorganisms.
3. Wear a respiratory device when entering the room of a client who is known or suspected
of having primary tuberculosis.
4. Susceptible people should not enter the room of a client who has rubella (measles) or
varicella (chicken pox). If they must enter they should wear a respirator.
5. Limit movement of client outside the room to essential purposes. Place a surgical mask
on the client if possible.
Droplet Precautions:
1. Place client in a private room.
2. If a private room is not available, place client with another client who is infected with the
same microorganisms.
3. Wear a mask if working within 3 feet of the client.
4. Transport client outside the room only when necessary and place a surgical mask on the
client if possible.
Contact precautions:
1. Place client in a private room.
2. If a private room is not available, place client with another client who is infected with the
same microorganism.
3. Wear gloves as described in standard precautions.
4. Wear gown when entering a room if there is a possibility of contact with infected surfaces
or items, or if the client is incontinent, has diarrhea, a colostomy or wound drainage.
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Suctioning
Nebulization
Intercostal drainage insertion and dressing
Bronchoscopy
Sputum collection in poorly ventilated areas
Surgery
Handling mycobacterium cultures
Cleaning suction cups
Post-mortem care
Open windows.
Ensure proper airflow direction in wards with TB patients.
Supervise proper patient placement and spatial separation ideally 3 feet, of
persons with respiratory infections in OPD and between beds in infectious wards
to reduce risk of transmission of droplet infection.
Dos
Use needle cutter or destroyer
immediately after use.
Separate sharps from other waste.
Use rigid, puncture proof disposal
bins.
Empty sharp containers when they
are full.
Hand hygiene:
Hand hygiene includes an instant alcohol hand antiseptic before and after providing client care,
hand washing with soap and water when hands are visibly soiled, and performing surgical scrub.
Hand washing is a vigorous, brief rubbing together of all surfaces of the hands lathered in soap,
followed by rinsing under a stream of water (CDC, 2002). The decision of when and what type
of hand hygiene should occur depends on the following:
-
The use of alcohol-based waterless antiseptics is recommended by the CDC (2002) to improve
hand hygiene practices, protect health care workers hands, and reduce transmission of pathogens
to clients and personnel in health care settings.
The CDC recommends the following:
1. Wash hands with plain soap or with antimicrobial soap and water when hands are visibly
dirty.
2. If hands are not visibly soiled, use an alcohol based waterless antiseptic agent for
routinely decontaminating hands in all other clinical situations:
a) After contact with a clients intact skin (as in taking a pulse or blood pressure, or
lifting a client)
b) After contact with body fluids or excretions, mucous membranes, non intact skin,
or wound dressings as long as hands are not visibly soiled.
c) When moving from a contaminated body site to a clean body site during client
care; after contact with inanimate objects in the immediate vicinity of the client.
d) Before caring for clients with severe neutropenia or other forms of severe
immune suppression.
e) Before inserting indwelling urinary catheters or other invasive devices.
f) After removing gloves.
Personal protective equipment (PPE):
PPE is designed to protect employees from workplace injuries or serious illnesses resulting from
contact with chemical, radiological, physical or mechanical or other workplace hazards.
PPE
Gloves
When to wear
Wear sterile gloves when
handling sterile procedures.
Eye wear
Gowns and
aprons
Masks
(cloth and
paper)
Caps
Footwear
Intelligent
Neatness
Faithfulness
Energetic
Courageous
Truthful, tactful
Immediate action
Organized
Non-threatening
Conscious
Orient
Nursing
Touch
Reactive
Observant
Listening
BIBLIOGRAPHY:
1. Francis CM de Souza Mario C; Hospital Administration; 3rd Edition; Jaypee Publications;
Page No. 329-340.
2. Dr. Sahni Ashok Clinical Updates and Management of Nursing Services; 2nd Edition;
Page No. 159-175.
3. Sayer Jean C, Deady M. Emilie; Hospital Administration Manual; Mosby Publications;
Page No. 291-292.
4. Anathanarayan R; Textbook of Microbiology; 6th Edition; Orient Longman Publications;
Page No. 61.
5. Perry and Potter; Basic Nursing; 5th Edition; Mosby Publications; Page No. 148-150.
6. Kozier. Erb.Blias. Wilkinson; Fundamentals of Nursing; 5th Edition; Page No. 679-682.
7. Perry and Potter; Fundamentals of Nursing; 6th Edition; Elsevier Publications; Page No.
773-777.
8. Brunner and Suddarths Textbook of Medical surgical Nursing; 10th Edition; Lippincott
publications; Page No. 2115.
9. Basavanthappa B.T.; Nursing Administration; 1st Edition; jaypee publications; Page No.
381-385.