DESIGNING AND IMPLEMENTING HOSPITAL INFECTION CONTROL PROGRAM

1. DESIGNING AND IMPLEMENTING HOSPITAL INFECTION CONTROL PROGRAM Dr. O. O. Oduyebo

2. Interruption of the chain of infection is a strategy to limit the spread of infection. • Infection requires three main elements • a source of the infectious agent, • a mode of transmission • a susceptible host.

3. The modes of transmission • In healthcare settings infectious agents can be transmitted by: • Contact • Droplet • Airborne

4. Contact transmission • Direct transmission occurs when the transfer of microorganisms results from direct physical contact between an infected or colonised individual and a susceptible host, • for example a HCW’s contaminated hands touch a vulnerable site (such as a wound) on a patient. • Indirect transmission involves the passive transfer of an infectious agent to a susceptible host via an intermediate object or fomite. • Examples of intermediate objects include instruments, bed rails, bed, tables and other environmental surfaces.

5. Droplet transmission • Droplet transmission occurs when respiratory droplets generated via coughing, sneezing or talking makes contact with susceptible mucosal surfaces, such as the eyes, nose or mouth. • Transmission may also occur indirectly via contact with contaminated fomites with hands and then mucosal surfaces. • Respiratory droplets are large and are not able to remain suspended in the air thus they are usually dispersed over short distances.

6. Airborne transmission • Airborne transmission refers to infectious agents that are spread via droplet nuclei (residue from evaporated droplets) containing infective microorganisms. • These organisms can survive outside the body and remain suspended in the air for long periods of time. • They infect others via the upper and lower respiratory tracts.

7. Methods of reducing the spread of infection • Standard Precautions • Transmission based Precautions

8. Standard precautions • refer to those work practices that are applied to everyone, regardless of their perceived or confirmed infectious status • and ensure a basic level of infection prevention and control. • Implementing standard precautions as a first-line approach to infection prevention and control in the healthcare environment minimises the risk of transmission of infectious agents from person to person, even in high-risk situations.

9. Standard precautions include: • Hand hygiene, before and after every episode of patient contact (ie 5 Moments for Hand Hygiene) • Use of personal protective equipment (PPE) • Safe use and disposal of sharps • Routine environmental cleaning • Respiratory hygiene and cough etiquette • Aseptic non-touch technique • Waste management • Appropriate handling of linen.

10. Transmission based Precautions • The first line of prevention of infection is the use of standard precautions. • Transmission-based precautions are additional work practices for specific situations where standard precautions are not sufficient to interrupt transmission • These precautions are tailored to the particular infectious agent and its mode of transmission.

11. If contact transmission: • Place the patient in an isolation room and limit access. • Wear gloves during contact with patient and with infectious body fluids or contaminated items. • Reinforce handwashing throughout the health facility. • Wear two layers of protective clothing. • Limit movement of the patient from the isolation room to other areas. • Avoid sharing equipment between patients. • Designate equipment for each patient, if supplies allow. • If sharing equipment is unavoidable, clean and disinfect it before use with the next patient.

12. If droplet transmission: • Place the patient in an isolation room. • Wear a HEPA or other biosafety mask when working with the patient. • Limit movement of the patient from the room to other areas. • If patient must be moved, place a surgical mask on the patient.

13. If airborne transmission • Place the patient in an isolation room that is not air-conditioned or where air is not circulated to the rest of the health facility. • Make sure the room has a door that can be closed. • Wear a HEPA or other biosafety mask when working with the patient and in the patients room. • Limit movement of the patient from the room to other areas. • Place a surgical mask on the patient who must be moved.

14. Hospital infections • Patients with infections are always on hosp admission • Hospital patients are immunosuppressed • Cross-infection is common • Determine magnitude of infection (important) • Preventive measures to keep infection rates to a minimum

15. INFECTION CONTROL (IPC) • Infection prevention and control • Is a process where activities, policies and procedures are designed to control and prevent the transmission of infectious diseases within the healthcare environment and the community

16. FOR an effective IPC • HCWs should understand the modes of transmission of infectious organisms • knowing how and when to apply the basic principles of infection prevention • is critical to the success of an infection control program.

17. RESPONSIBILITY • This responsibility applies to everybody working and visiting a healthcare facility • including administrators, staff, students, patients, their family. INFECTION PREVENTION AND CONTROL IS EVERYBODY’S BUSINESS

18. Infection Control Program • To be effective, control programs should include: • Adequate number of infection control staff • Education • Organised surveillance and control activities • A system of reporting infection rates back to the concerned medical care staff

19. Human resources • Training for all health-care personnel • Specialized training of infection control professionals • Adequate staff responsible for IPC activities. • Address biological risk and implement preventive measures.

20. Infection control staff • Infection control program is usually directed by the: • infection control team • infection control committee

21. Infection control team • consists of • a doctor with a special interest in infection • a nurse whose primary occupation is infection control • A technologist if the doctor is not a laboratory staff • This small team does the day to day surveillance and takes action when outbreaks occur.

22. Infection control committee • The committee should represent the major medical specialties, nursing staff, catering, engineering (maintanance) and hospital administration • provides a forum to discuss policies and gives authority for control measures

23. Surveillance • Regular collection, collation and analysis of information on infection events and rates either continuously or at regular interval and the timely dissemination and feedback to those who need to know

24. Types of surveillance • Will be dictated by the • no of IPC staff available to collect the information • the resources • skills to interpret data once collected • Continuous (total or selective) • Periodic (point prevalence)

25. Continuous alert organism surveillance • Review of lab tests for the presence of significant organisms as an indicator of the status of infection in the hospital • Alert org – bacteria specifically noted on lab reports as requiring immediate intervention by the IPC team –MRSA, MDR –GNB or M. tuberculosis

26. Continuous alert condition surveillance • Focused on groups of patients most likely to acquire an infection or who are particularly vulnerable should they acquire infection • Requires close liaison between IPC staff and ward staff and relies on ward staff being able to • identify those patients who should be monitored and • recognise an infection from the patient’s condition e g

27. ICU • where blood stream infections, IV therapy infections or SSIs are recorded, • diarrhoeal disease • TB occurring in a particular ward

28. Point prevalence • – surveys taken at a point in time • Of patients according to certain characteristics • Can be applied to a single unit or nationally • e g antenatal survey for HIV among pregnant women in LUTH to assess prevalence of HIV in this group

29. Selective laboratory based ward liaison survey • Lab and staff ward review selected surveillance data • Can reveal an increase in the incidence of infection in a healthcare setting before it becomes a problem • Useful where resources are short in both staff and funds • Can be set up in a unit which requires the most attention

30. Hospital wide surveillance • Review hospital culture results • Follow up to assess patients to determine whether hospital or community acquired • Review with clear definitions of hospital acquired infection for the type of infection • Calculate monthly rates

31. INFECTION RATE = No of infected patients x 100 Total no of patients in hops

32. There must be clear definition of infections • There must be appropriate denominators to calculate rate of infection • Data entry must be accurate • Communication and reporting structures must be clear • Data must be analysed periodically and presented to the infection control committee to be used to develop policies and for IPC structural support

33. Uses of surveillance • Provides data to • identify infected patients • determine the rate of infection • the factors that contributed to the infection. • When infection problems are recognized, the hospital is able to institute appropriate intervention measures and evaluate their efficacy • Helps to assess the quality of care in the hospital

34. Role of the laboratory in infection control program • microbiology data for surveillance and IPC activities. • To make lab results available in an organized, accessible and timely manner through proper record keeping systems. • Monitor lab results for • Unusual findings e.g. cluster of pathogens that may indicate an outbreak • Emergence of multi-drug resistant organisms • Isolation of highly infectious, unusual and virulent pathogens • Environmental cultures to assess microbial contamination of inanimate objects or the level of contamination in certain areas of the hospital.

35. Bacteriological investigation • This is done according to the circumstance of the outbreak and nature of the causative organism • In staphylococcal or streptococcal sepsis, attention will be focused on humans • but in outbreaks due to Gram negative bacilli, attention will be focused on utensils, apparatus or fluids. • There is need for supporting epidemiological evidence that infected patients had significant contact with the source of infection.

36. Whether infections were caused by identical bacteria or various organisms. • Infections due to identical bacteria may suggest a human carrier while an outbreak due to various organisms suggest a breakdown in • the theatre or ward ventilation • aseptic techniques • sterilization of dressings or instruments.

37. ENDING AN OUTBREAK • An outbreak will be brought to an end by • by effectively treating or removing to isolation infected persons whether cases or carriers • by destroying micro-organisms that are environmental sources of infection • by detecting and correcting specific technical lapses in hospital procedures

38. ICT • preparing the yearly work plan for the program, for review by the infection control committee and administration • They have a scientific and technical support role: e.g. surveillance and research, developing and assessing policies and practical supervision, evaluation of material and products, control of sterilization and disinfection, implementation of training programmes. • They should also support and participate in research and assessment programmes at the national and international levels.

39. Role of hospital management • The administration hospital must provide leadership by supporting the hospital infection programme. • They are responsible for: • establishing a multidisciplinary Infection Control Committee • identifying appropriate resources for a programme to monitor infections and apply the most appropriate methods for preventing infection

40. delegating technical aspects of hospital hygiene to appropriate staff, such as: • nursing • housekeeping • maintenance • clinical microbiology laboratory • periodically reviewing the status of nosocomial infections and effectiveness of interventions to contain them • reviewing, approving, and implementing policies approved by the Infection Control Committee • ensuring the infection control team has authority to facilitate appropriate programme function • participating in outbreak investigation

41. Role of the physician • Physicians have unique responsibilities for the prevention and control of hospital infections: • by providing direct patient care using practices which minimize infection • by following appropriate practice of hygiene (e.g. handwashing, isolation) • serving on the Infection Control Committee • supporting the infection control team.

42. Physician • protecting their own patients from other infected patients and from hospital staff who may be infected • complying with the practices approved by the Infection Control Committee • obtaining appropriate microbiological specimens when an infection is present or suspected • notifying cases of hospital-acquired infection to the team, as well as the admission of infected patients

43. complying with the recommendations of the Antimicrobial Use Committee regarding the use of antibiotics • advising patients, visitors and staff on techniques to prevent the transmission of infection • instituting appropriate treatment for any infections they themselves have, and taking steps to prevent such infections being transmitted to other individuals, especially patients.

44. Role of the hospital pharmacist (5) •  obtaining, storing and distributing pharmaceutical preparations using practices which limit potential transmission of infectious agents to patients • dispensing anti-infectious drugs and maintaining relevant records (potency, incompatibility, conditions of storage and deterioration) • obtaining and storing vaccines or sera, and making them available as appropriate • maintaining records of antibiotics distributed to the medical departments • providing the Antimicrobial Use Committee and Infection Control Committee with summary reports and trends of antimicrobial use

45. Pharmacist • having available the following information on disinfectants, antiseptics and other anti-infectious agents: • active properties in relation to concentration, temperature, length of action, antibiotic spectrum • toxic properties including sensitization or irritation of the skin and mucosa — substances that are incompatible with antibiotics or reduce their potency • physical conditions which unfavourably affect potency during storage: temperature, light, humidity • harmful effects on materials.

46. Pharmacist • The hospital pharmacist may also participate in the hospital sterilization and disinfection practices through: • participation in development of guidelines for antiseptics, disinfectants, and products used for washing and disinfecting the hands • participation in guideline development for reuse of equipment and patient materials • participation in quality control of techniques used to sterilize equipment in the hospital including selection of sterilization equipment (type of appliances) and monitoring.

47. Role of the nursing staff • participating in the Infection Control Committee • promoting the development and improvement of nursing techniques, and ongoing review of aseptic nursing policies, with approval by the Infection Control Committee • developing training programmes for members of the nursing staff • supervising the implementation of techniques for the prevention of infections in specialized areas such as the operating suite, the intensive care unit, the maternity unit and newborns • monitoring of nursing adherence to policies.

48. The nurse in charge of a ward is responsible for: • maintaining hygiene, consistent with hospital policies and good nursing practice on the ward • monitoring aseptic techniques, including handwashing and use of isolation • reporting promptly to the attending physician any evidence of infection in patients under the nurse’s care

49. limiting patient exposure to infections from visitors, hospital staff, other patients, or equipment used for diagnosis or treatment • maintaining a safe and adequate supply of ward equipment, drugs and patient care supplies.

50. The nurse in charge of infection control is a member of the infection control team and responsible for : • identifying nosocomial infections • investigation of the type of infection and infecting organism • investigation of the type of infection and infecting organism • participating in training of personnel