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Infection Control, Principles and Practice

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Infection control principles and practice l.jpg

INFECTION CONTROLPrinciples AND Practice

Dr.T.V.Rao MD

Dr.T.V.Rao MD


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A Tribute to Ignaz Semmelweiss (1818-1865)

Ignaz Semmelweiss (1818-1865)

  • Obstetrician, practised in Vienna

  • Studied puerperal (childbed) fever

  • Established that high maternal mortality was due to failure of doctors to wash hands after post-mortems

  • Reduced maternal mortality by 90%

  • Ignored and ridiculed by colleagues

Dr.T.V.Rao MD


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History of infection control and hospital epidemiology in the USA

  • Pre 1800: Early efforts at wound prophylaxis

  • 1800-1940: Nightingale, Semmelweis, Lister, Pasteur

  • 1940-1960: Antibiotic era begins, Staph. aureus nursery outbreaks, hygiene focus

  • 1960-1970’s: Documenting need for infection control programs, surveillance begins

  • 1980’s: focus on patient care practices, intensive care units, resistant organisms, HIV

  • 1990’s: Hospital Epidemiology = Infection control, quality improvement and economics

  • 2000’s: ??Healthcare system epidemiology

modified from McGowan, SHEA/CDC/AHA training course

Dr.T.V.Rao MD


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Why do we need Infection Control??

Hospitals and clinics are complex institutions where patients go to have their health problems diagnosed and treated

But, hospitals, clinics, and medical/surgical interventions introduce risks that may harm a patient’s health

Dr.T.V.Rao MD


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What is Nosocomial Infection

  • Any infection that is not present or incubating at the time the patient is admitted to the hospital

Dr.T.V.Rao MD


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Consequences of Nosocomial Infections

  • Additional morbidity

  • Prolonged hospitalization

  • Long-term physical, developmental and neurological sequelae

  • Increased cost of hospitalization

  • Death

Dr.T.V.Rao MD


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Florence Nightingale

  • It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm"

Dr.T.V.Rao MD


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Links to the Chain of Infection

  • Portal of Entry

  • Susceptible Host

  • Causative Agent

  • Reservoir

  • Portal of Exit

  • Mode of Transmission

Dr.T.V.Rao MD


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Hospital Infections are Emerging challenges in Health Care

  • Hospital-associated infections represent a serious and growing health problem. The Centers for Disease Control and Prevention (CDC) estimates that 2 million people acquire hospital-associated infections each year and that 90 000 of these patients die as a result of their infections. A variety of hospital-based strategies aimed at preventing such infections have been proposed.

Dr.T.V.Rao MD


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Modern Hospital Infection Control

  • Modernhospital infection control programs first began in the 1950s in England, where the primary focus of these programs was to prevent and control hospital-acquired staphylococcal outbreaks. In 1968, the American Hospital Association published "Infection Control in the Hospital," the first and only standards available for many years. At the same time, the Communicable Disease Center, later to be renamed the Centers for Disease Control and Prevention (CDC), began the first training courses specifically about infection control and surveillance

Dr.T.V.Rao MD


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CHAIN OF INFECTION

Dr.T.V.Rao MD


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Beginning of Accreditation

  • In 1969, the Joint Commission for Accreditation of Hospitals--later to become 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


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CDCInitiates Hospital Infection Branch

  • In 1972, the Hospital Infections Branch at the CDC was formed and the Association for Practitioners in Infection Control was organized. By the close of the decade, the first CDC guidelines were written to answer frequently asked questions and establish consistent practice.

Dr.T.V.Rao MD


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First Data on Infection Control Efficacy

  • In 1985, the Study of the Efficacy of Nosocomial Infection Control (SENIC) project was published, validating the cost-benefit of infection control programs. Data collected in 1970 and 1976-1977 suggested that one-third of all nosocomial infections could be prevented

Dr.T.V.Rao MD


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Committee Suggested

  • One infection control professional (ICP) for every 250 beds. An effective infection control physician. A program reporting infection rates back to the surgeon and those clinically involved with the infection. An organized hospital-wide surveillance system.

Dr.T.V.Rao MD


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Infection Control Challenges of Healthcare in 2000

  • Decreasing reimbursement

  • Increasing emerging infections

  • Increasing resistant organisms

  • Increasing drug costs

  • Institute of Medicine Report--healthcare-associated infections

  • Nursing shortage

  • OSHA safety legislation

  • Multiple benchmark systems

  • FDA legislation on reuse of single-use devices

Dr.T.V.Rao MD


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The nature of infections

  • Micro-organisms - bacteria, fungi, viruses, protozoa and worms

  • Most are harmless [non-pathogenic]

  • Pathogenic organisms can cause infection

  • Infection exists when pathogenic organisms enter the body, reproduce and cause disease

Dr.T.V.Rao MD


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Modes of spread

Two sources of infection:

  • Endogenous or self-infection - organisms which are harmless in one site can be pathogenic when transferred to another site e.g., E. coli

  • Exogenous or cross-infection - organisms transmitted from another source e.g., nurse, doctor, other patient, environment (Peto, 1998)

Dr.T.V.Rao MD


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Spread - entry and exit routes

  • Natural orifices - mouth, nose, ear, eye, urethra, vagina, rectum

  • Artificial orifices - such as tracheostomy, ileostomy, colostomy

  • Mucous membranes - which line most natural and artificial orifices

  • Skin breaks - either as a result of accidental damage or deliberate inoculation/incision (May, 2000)

Dr.T.V.Rao MD


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HAI - common bacteria

  • Staphylococci - wound, respiratory and gastro-intestinal infections

  • Escherichia coli - wound and urinary tract infections

  • Salmonella - food poisoning

  • Streptococci - wound, throat and urinary tract infections

  • Proteus - wound and urinary tract infections (Peto, 1998)

Dr.T.V.Rao MD


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HAI - common viruses

  • Hepatitis A - infectious hepatitis

  • Hepatitis B - serum hepatitis

  • Human immunodeficiency virus [HIV] - acquired immunodeficiency syndrome [AIDS] (Peto, 1998)

Dr.T.V.Rao MD


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Components of Infection Control Programme

  • The important components of the infection control programme are:

  • ·Basic measures for infection control, i.e. standard and additional precautions; · education and training of health care workers; · protection of health care workers, e.g. immunization; identification of hazards and minimizing risks; · routine practices essential to infection control such as aseptic techniques, use of single use devices, reprocessing of instruments and equipment, antibiotic usage, management of blood/body fluid exposure, handling and use of blood and blood products, sound management of medical waste;

Dr.T.V.Rao MD


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Need For Control programme?

  • Effective work practices and procedures, such as environmentalmanagement practices including management of hospital/clinical waste, support services (e.g., food, linen), use of therapeutic devices; surveillance; · incident monitoring; outbreak investigation; infection control in specific situations; and research.

Dr.T.V.Rao MD


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Developing Infection Control Programme

  • Every infection control program should develop a well-defined written plan outlining the organizational philosophy regarding infection prevention and control. The plan should take into account the goals, mission statement, and an assessment of the infection control program. It should include a statement of authority, and should review patient demographics including geographic locations of patients served by the healthcare system

Dr.T.V.Rao MD


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Administrative control measures Assignment of responsibilities

Responsibility on implementing, monitoring, enforcing, evaluating, and revising infection control programs on a routine basisincluding linkage to TB diagnostics and other communicable Infections

Dr.T.V.Rao MD


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Infection control committee

  • An infection control committee provides a forum for multidisciplinary input and cooperation, and information sharing. This committee should include wide representation from relevant departments: e.g. management, physicians, other health care workers, clinical microbiology, pharmacy, sterilizing service, maintenance, housekeeping and training services. The committee must have a reporting relationship directly to either administration or the medical staff to promote programme visibility and effectiveness.

Dr.T.V.Rao MD


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Prevention of Hospital Infection-Planning

  • Implemented, monitored and enforced IC plan

  • Educated and trained HCW to ensure good work practices

  • Counselling and screening HCW periodically

  • Evaluated and revised plan 4 times

LIFECYCLE OF IC PLAN

Develop

Evaluate Revise

Implement

Dr.T.V.Rao MD


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The Infection Control Team

  • Consist of at least an infection control practitioner who should be trained for the purpose; carry out the surveillance programme; develop and disseminate infection control policies; monitor and manage critical incidents; coordinate and conduct training activities.

Dr.T.V.Rao MD


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Infection Control Committee Purpose

  • Advisory

    • Review ideas from infection control team

    • Review surveillance data

  • Expert resource

    • Help understand hospital systems and policies

  • Decision making

    • Review and approve policies and surveillance plans

    • Policies binding throughout hospital

  • Education

    • Help disseminate information and influence others

Dr.T.V.Rao MD


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Infection Control Committee - Represented

Committee Representatives

  • Hospital Epidemiologist

  • Infection Control Practitioners

  • Administrator

  • Ward, ICU and Operating room Nurses

  • Medicine/Surgery/Obstetrics/Pediatrics

  • Central Sterilization

  • Hospital Engineer

  • Microbiologist

  • Pharmacist

Dr.T.V.Rao MD


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Skin shaved the night before surgery

Inappropriate peri-op antibiotic prophylaxis

Instruments used for dressing changes submerged disinfectant

Large containers of antiseptics, no routine for cleaning and refilling

Eliminate shaving of skin the night before surgery

Single dose peri-op antibiotic prophylaxis guidelines

Use individual sterile packs of wound care instruments

Use small containers of antiseptics; clean and dry containers before refilling

Identify problems with polices and procedures Example: Pre- and Post-Operative Carecreate your protocols

Problem Area

Recommendation

Dr.T.V.Rao MD


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Aims of Infection Control

  • To review and approve a yearly programme of activity for surveillanceand prevention; to review epidemiological surveillance data and identify areas for intervention; to assess and promote improved practice at all levels of the health facility; to ensure appropriate staff training in infection control and safety management, provision of safety materials such as personal protective equipment and products; and training of health workers.

Dr.T.V.Rao MD


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Education is the Real Strength of Infection Control programme

  • Education programs for employees and volunteers 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. Much has been written about the education of healthcare workers (HCWs).

Dr.T.V.Rao MD


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Minimal Needs to Start Infection Control Unit

  • 1 Organized surveillance and control activities 2. One infection control practitioner for every major Health Facility. 3. A Trained Hospital Epidemiologist 4. A system for reporting surgical wound infection rates and other infection back to the practicing surgeons and physicians.

Dr.T.V.Rao MD


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GUIDELINES for Effective Control of Infections

  • Hand washing and Hospital Environmental Control * Immunization * Infectious Diseases Control * Intravascular Device-Related Infections and its control * Isolation Precautions * Long-Term Care Facilities

Dr.T.V.Rao MD


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GUIDELINES for Effective Control of Infections

  • * Guidelines for Infection Control in Health Care Personnel * Surgical Site Infections Control * Urinary Tract and Respiratory Tract Infections Control * Ordering and Preparing Guidelines appropriately

  • * Home care

  • * Hospital Construction

  • * Sterilization / Disinfection

Dr.T.V.Rao MD


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Your Unwashed Hand a Great Concern to Your Patient

Dr.T.V.Rao MD


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Hand Washing is the Foundation of Infection Control

  • Hand washing is the single most important procedure for preventing nosocomial infections. Hand washing is defined as a vigorous, brief rubbing together of all surfaces of lathered hands, followed by rinsing under a stream of water. Although various products are available, hand washing can be classified simply by the nature of the products used:

  • plain soap

  • detergents

  • Antimicrobial containing products

Dr.T.V.Rao MD


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Hand Washing is the Foundation of Infection Control

  • Hand washing with plain soaps or detergents (in bar, granule, leaflet or liquid form) suspends microorganisms and allows them to be rinsed off; this process is often referred to as mechanical removal of microorganisms. In addition, hand washing with antimicrobial containing products kills or inhibits the growth of microorganisms; this process is often referred to as chemical removal of microorganisms.

Dr.T.V.Rao MD


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Hand washing Technique

  • For routine hand washing, a vigorous rubbing together of all surfaces of lathered hands for at least 10 seconds, followed by thorough rinsing under a stream of water, is recommended.

Dr.T.V.Rao MD


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Hand washing

  • Single most effective action to prevent HAI - resident/transient bacteria

  • Correct method - ensuring all surfaces are cleaned - more important than agent used or length of time taken

  • No recommended frequency - should be determined by intended/completed actions

  • Research indicates:

    • poor techniques - not all surfaces cleaned

    • frequency diminishes with workload/distance

    • poor compliance with guidelines/training

Dr.T.V.Rao MD


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Taylor (1978) identified that 89% of the hand surface was missed and that the areas of the hands most often missed were the finger-tips, finger-webs, the palms and the thumbs.

Hand washing – Areas Missed

Dr.T.V.Rao MD


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Successful Promotionin Hand Washing 

  • Education

  • Routine observation & feedback

  • Engineering controls

    • Location of hand basins

    • Possible, easy & convenient

    • Alcohol-based hand rubs available

  • Patient education

    (Improving Compliance with Hand Hygiene in Hospitals. Didier Pittet. Infection Control and Hospital Epidemiology. Vol. 21 No. 6 Page 381)

Dr.T.V.Rao MD


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Successful Promotioncan Improve Hand Washing 

  • Reminders in the workplace

  • Administrative sanctions ??

  • Change in hygiene agent (not in Winter)

  • Promote and facilitate skin care

  • Avoid understaffing and excessive workload

Dr.T.V.Rao MD


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Hand Hygiene TechniquesMany Ways

  • Alcohol hand rub

  • Routine hand wash 10-15 seconds

  • Aseptic procedures 1 minute

  • Surgical wash 3-5 minutes

Dr.T.V.Rao MD


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Advantages of Alcoholic Hand Wash

  • Require less time

  • Can be strategically placed

  • Readily accessible

  • Multiple sites

  • All patient care areas

  • Acts faster

  • Excellent bactericidal activity

  • Less irritating (??)

  • Sustained improvement

Dr.T.V.Rao MD


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Antibiotic resistanceNot a new problem - Penicillin in 1944

  • Hospital “superbugs”

  • Methicillin Resistant Staphylococcus Aureus [MRSA]

  • Vancomycin Intermediate Staphylococcus Aureus [VISA]

  • Tuberculosis - antibiotic resistant an Emerging Global Concern

Dr.T.V.Rao MD


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MRSA

  • Discovered in 1981

  • Found on skin and in the nose of 1 in 3 healthy people - symptomless carriers

  • Widespread in hospitals and community

  • Resistant to most antibiotics

  • When fatal - often due to septicaemia

Dr.T.V.Rao MD


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Hospital Acquired Infections and Consequences

  • Incidence of 10%

  • 5,000 deaths per year - direct result of HAI

  • 15,000 deaths per year linked to HAI

  • Delayed discharge from hospital

  • Expensive to treat [£3,500 extra]

  • Cost to NHS - £1 billion per year

  • Effective hand washing is the most effective preventative measure

  • Dirty wards and re-use of disposable equipment also blamed

Dr.T.V.Rao MD


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The nature of infection

  • Micro-organisms - bacteria, fungi, viruses, protozoa and worms

  • Most are harmless [non-pathogenic]

  • Pathogenic organisms can cause infection

  • Infection exists when pathogenic organisms enter the body, reproduce and cause disease

Dr.T.V.Rao MD


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Staff health

  • Risk of acquiring and transmitting infection

  • Acquiring infection

    • immunisation

    • cover lesions with waterproof dressings

    • restrict non-immune/pregnant staff

  • Transmitting infection

    • advice when suffering infection

  • Report accidents/untoward incidents

  • Follow local policy (May, 2000)

Dr.T.V.Rao MD


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Waste disposal

  • Clinical waste - HIGH risk

    • potentially/actually contaminated waste including body fluids and human tissue

    • yellow plastic sack, tied prior to incineration

  • Household waste - LOW risk

    • paper towels, packaging, dead flowers, other waste which is not dangerously contaminated

    • black plastic sack, tied prior to incineration

  • Follow local policy (May, 2000)

Dr.T.V.Rao MD


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Spillage of body fluids

  • PPE - disposable gloves, apron

  • Soak up with paper towels, kitchen roll

  • Cover area with hypochlorite solution e.g., Milton, for several minutes

  • Clean area with warm water and detergent, then dry

  • Treat waste as clinical waste -yellow plastic sack

  • Follow local policy (May, 2000)

Dr.T.V.Rao MD


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Standard Precautions

  • Hand hygiene

  • Respiratory hygiene and cough etiquette

  • Personal protective equipment (PPE)

    Based on risk assessment to avoid contact with blood, body fluids, excretions, secretions

  • Safe injection practices

  • Environmental control

  • Patient placement

Dr.T.V.Rao MD


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Nosocomial Infections are great concern in Immune compromised Patients

Immunocompromised patients vary in their susceptibility to nosocomial infections, depending on the severity and duration of immunosuppression. Use of the two tiered system essential to break the “Chain of Infection”.

Dr.T.V.Rao MD


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Strengthen the Epidemiology

Epidemiology is the scientific process applied to the control of infections in the healthcare setting.

Dr.T.V.Rao MD


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Surveillance for nosocomial infection

bloodstream infections

pneumonia

urinary tract infections

surgical wound infections

Patterns of transmission of nosocomial infections

Outbreak investigation

Isolation precautions

Evaluation of exposures

Employee health

Disinfection and sterilization

Hospital engineering and environment

water supply

air filtration

Reviewing policies and procedures for patient care

Areas of interest to a hospital epidemiologist

Dr.T.V.Rao MD


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Areas of interest to a Hospital Epidemiologist

  • Antibiotic use

  • Antibiotic resistant pathogens

  • Microbiology support

  • National regulations on infection control

  • Infection control committee

  • Quantitative methods in epidemiology

Dr.T.V.Rao MD


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What is the role of healthcare epidemiology?

Eliminate or minimize risks to a patient’s health

  • organize care to minimize risk

    • eliminate risk factors

    • work around risk factors

    • develop improved policies and procedures

  • educate physicians and nurses regarding risks

  • study risk factors to learn more about them and how to eliminate them

Dr.T.V.Rao MD


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Surveillance of nosocomial infections

Outbreak investigation

Develop written policies for isolation of patients

Develop written policies to reduce risk from patient care practices

Cooperation with occupational health

Education of hospital staff on infection control

Ongoing review of all aseptic, isolation and sanitation techniques

Eliminate wasteful or unnecessary practices

Responsibilities of the Infection Control Program

Dr.T.V.Rao MD


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Key elements of surveillance

  • Defining as precisely as possible the event to be surveyed (case definition)

  • Collecting the relevant data in a systematic, valid way

  • Consolidating the data into meaningful arrangements

  • Analyzing and interpreting the data

  • Using the information to bring about change

adapted from R. Haley

Dr.T.V.Rao MD


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Surveillance for nosocomial infection

Patterns of transmission of nosocomial infections

Outbreak investigation

Isolation precautions

Evaluation of exposures

Employee health

Disinfection and sterilization

Hospital engineering and environment

water supply

air filtration

Reviewing policies and procedures for patient care

Areas of interest to a healthcare epidemiologist

Dr.T.V.Rao MD


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Organizing for Infection Control

  • Requires cooperation, understanding and support of hospital administration and medical/surgical/nursing leadership

  • There is no simple formula:

    • Every facility is different

    • Every facility’s problems are different

    • Every facility’s personnel are different

  • The facility must develop its own unique program

Dr.T.V.Rao MD


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Methods to reduce cost of Nosocomial Infections

  • Reduce incidence

  • Reduce morbidity

  • Shorten hospital stay

  • Reduce costs of treating infections

  • Reduce costs of preventative measures

  • Stop ineffective control measures

Dr.T.V.Rao MD


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Universal infection control precautions

  • Devised in US in the 1980’s in response to growing threat from HIV and hepatitis B

  • Not confined to HIV and hepatitis B

  • Treat ALL patients as a potential bio-hazard

  • Adopt universal routine safe infection control practices to protect patients, self and colleagues from infection

Dr.T.V.Rao MD


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Universal PrecautionsInclude

  • Hand washing

  • Personal protective equipment [PPE]

  • Preventing/managing sharps injuries

  • Aseptic technique

  • Isolation

  • Staff health

  • Linen handling and disposal

  • Waste disposal

  • Spillages of body fluids

  • Environmental cleaning

  • Risk management/assessment

Dr.T.V.Rao MD


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Personal protective equipment

  • PPE when contamination or splashing with blood or body fluids is anticipated

  • Disposable gloves

  • Plastic aprons

  • Face masks

  • Safety glasses, goggles, visors

  • Head protection

  • Foot protection

  • Fluid repellent gowns (May, 2000)

Dr.T.V.Rao MD


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Personal protective equipment

  • PPE when contamination or splashing with blood or body fluids is anticipated

  • Disposable gloves

  • Plastic aprons

  • Face masks

  • Safety glasses, goggles, visors

  • Head protection

  • Foot protection

  • Fluid repellent gowns (May, 2000)

Dr.T.V.Rao MD


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Eliminate waste:Unnecessary microbiologic monitoring

  • Routine environmental cultures of walls, floors, air, sinks, or other hospital surfaces

  • Routine cultures of healthcare workers nose and hands

  • Clinical cultures which are not available to clinicians in time to help with decision making

    Also: Failure to generate annual summary of culture data to provide clinicians with data for empirical selection of antibiotics

Dr.T.V.Rao MD


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Practice Aseptic techniques

  • Sepsis - harmful infection by bacteria

  • Asepsis - prevention of sepsis

  • Minimise risk of introducing pathogenic micro-organisms into susceptible sites

  • Prevent transfer of potential pathogens from contaminated site to other sites, patients or staff

  • Follow local policy (May, 2000)

Dr.T.V.Rao MD


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Antibiotic Prophylaxis in Surgery

  • Potentially an important part of surgical wound infection prevention

  • May also be a significant expense for the hospital

  • What is the cost-benefit of prophylactic antibiotics?

    • What is cost of wound infection? In money? In suffering?

    • How effective is prophylaxis?

    • How much can we spend to prevent a case of wound infection ?

Dr.T.V.Rao MD


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Sharps injuries

  • Prevention

    • correct disposal in appropriate container

    • avoid re-sheathing needle

    • avoid removing needle

    • discard syringes as single unit

    • avoid over-filling sharps container

  • Management

    • follow local policy for sharps injury (May, 2000)

Dr.T.V.Rao MD


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Protecting Yourself from Blood-Borne Pathogens

Dr.T.V.Rao MD


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HIV: 3 Infections per 1,000 Sticks with a HIV+ Needle

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Dr.T.V.Rao MD


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Hepatitis C: 18 Persons per 1,000Needle-sticks

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Dr.T.V.Rao MD


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Hepatitis B is Most Infectious

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Dr.T.V.Rao MD


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Protect Yourself! Get a Hepatitis B Vaccination and keep your Vaccine Record

  • 3 doses of Hepatitis B vaccine protect most people for a lifetime in Majority of Indivuasls

  • But HCW blood banks, and dialysis should follow the updated Instructions

  • The next dose at this facility will be given on

Dr.T.V.Rao MD


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Safe Handling of Sharps

  • Wear gloves when drawing blood or handling sharps—double glove for surgery

  • Don’t recap!

  • Don’t bend or break needles

  • Never place used sharps on tables, beds, furniture

  • Put used sharps immediately into a sharps container

Dr.T.V.Rao MD


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Disposal of Sharps: The Ideal

  • Immediately after use, put sharps in a leak- proof and puncture-proof container

  • The container should be within arm’s length


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Sharps Disposal (cont’d)

  • Disposal containers should be placed at all points of use

  • Disposal bin should be rigid and should be leak and puncture proof

  • Separate sharps from other waste so laundry workers or waste disposal staff do not get needlesticks

  • Empty sharps containers when they are ¾full

Dr.T.V.Rao MD


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Danger!

  • Open containers of used needles like this put staff at risk each time they put a hand in to pick up one

  • Keep your ward free of used sharps


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Remember this Procedure… When Injures with a Needle

  • If a needle pricks you or blood and/or body fluids enter your eye(s) or mouth

    • Wash wounds with soap and water

    • Flush eyes and mouth with water

    • Check the patient record to see if the patient is HIV+, HIV- , or untested

    • Check patient record for Hepatitis B or C infection

    • Call the medical duty officer immediately

Dr.T.V.Rao MD


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Wear gloves

Don’t recap needles

Complete 3 doses of Hep B vaccine

Eliminate unnecessary injections

Dispose of sharps immediately after use to minimise handling that increases risk of needlesticks

Substitute safer devices or tools whenever possible

Report needlesticks

Protecting Yourself from Blood-Borne Pathogens (cont’d)

Dr.T.V.Rao MD


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Prion diseases

  • Prions [“pree-ons”] - proteinaceous infectious particles

  • Corrupted form of a normally harmless protein found in mammals and birds

  • Causes fatal neurodegenerative diseases of animals and humans

  • Animals: scrapie - sheep, bovine spongiform encephalopathy [BSE or Mad Cow Disease]

  • Humans: Creutzfeldt-Jakob disease [CJD]

  • Prions found in blood, tonsil and appendix tissue

Dr.T.V.Rao MD


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Prions and surgery

  • Prions cannot be destroyed by sterilisation

  • Theoretical risk of cross infection from contaminated instruments and blood transfusion

Dr.T.V.Rao MD


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Wish to be Better Informed Internet sites

  • http://www.icna.co.uk/

  • http://www.nursing-standard.co.uk/

  • http://www.medscape.com/

  • http://www.anes.uab.edu/medhist.htm

  • http://www.shef.ac.uk/~nhcon/

  • http://medweb.bham.ac.uk/nursing/

  • http://www.healthcentre.org.uk/hc/library/default.htm

Dr.T.V.Rao MD


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Resources: Where to get more information or help

  • Training Courses

    • Society of Hospital Epidemiologists of America (SHEA)

    • Association of Professionals in Infection Control (APIC)

    • National courses and congresses

  • Books

    • Textbooks: Bennett and Brachman - Wenzel - Mayhall

    • APIC Curriculum and Guidelines

    • CDC Guidelines

  • Journals

    • Infection Control and Hospital Epidemiology

    • Journal of Hospital Infections

    • American Journal of Infection Control

  • Consulting services

    • National: CDC, Ministry of Health

    • Colleagues

Dr.T.V.Rao MD


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  • Created by Dr.T.V.Rao MD for ‘e’ Learning resources to Medical and Paramedical Health Care Workers in the Developing World

  • Email

  • doctortvrao@gmail.com

Dr.T.V.Rao MD


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