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Infection_control Powered By Docstoc
					  An Introduction to


Infection Control

  A PowerPoint Presentation
       by Eddie Newall
          May 2003
Learning outcomes
   Describe the sources of micro-organisms,
    routes of transmission and key principles
    of infection control
   List the essential elements of universal
    precautions
   Understand the importance of risk
    assessment and management in infection
    control
The pre-scientific era
   Epidemics and plagues throughout history
   Physicians fear of contagious disease
   Hippocrates and others suspected an
    unseen invisible cause
   Climate and environment blamed - not the
    ill, dying or dead
Microbiology - scientific era
Anton van Leeuwenhoek (1632-1722)
 Dutch linen draper
 Amateur scientist
 Grinding lenses, magnifying glasses, hobby
 First to see bacteria “little beasties”
 No link between bacteria and disease
Scientific era continued . . . . .
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
Scientific era continued . . . . .
Louis Pasteur (1822-1895)
 French professor of chemistry
 Studied how yeasts (fungi) ferment wine
  and beer
 Proved that heat destroys bacteria and
  fungi
 Proved that bacteria can cause infection -
  the “germ theory” of disease
Scientific era continued . . . . .
Joseph Lister (1827-1912)
 Scottish surgeon
 Recognised importance of Pasteur’s work
 Concerned about infection of compound
  fractures and post-operative wounds
 Developed carbolic acid spray to disinfect
  instruments, patient’s skin, surgeon’s skin
 Largely ignored by medical colleagues
Scientific era continued
Robert Kock (1843-1910)
 German general practitioner
 Grew bacteria in culture medium
 Showed which bacteria caused particular
  diseases
 Classified most bacteria by 1900
Contemporary issues
   Antibiotic resistance
   Prevalence of hospital acquired infection
   Prion diseases
Antibiotic resistance
   Not a new problem - Penicillin in 1944
   Hospital “superbugs”
   Methycillin Resistant Staphylococcus
    Aureus [MRSA]
   Vancomycin Intermediate Staphylococcus
    Aureus [VISA]
   Tuberculosis - antibiotic resistant form
     400 deaths per year in UK
     Up to £100,000 per patient to treat
     Annual NHS cost - £5 million
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
Hospital acquired infection
   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
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
Prions and surgery
                   Prions cannot be
                    destroyed by
                    sterilisation
                   Theoretical risk of
                    cross infection
                    from contaminated
                    instruments and
                    blood transfusion
Comparisons of mortality
Deaths per year in the UK

  20,000
  18,000
  16,000
  14,000
  12,000
  10,000
   8,000
   6,000
   4,000
   2,000
       0
           RTA   SUICIDE   HAI
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
Hospital acquired infection
   Infection which was neither present nor
    incubating at the time of admission
   Includes infection which only becomes
    apparent after discharge from hospital but
    which was acquired during hospitalisation
    (Rcn, 1995)
   Also called nosocomial infection
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)
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)
Chain of infection
   Source/reservoir of micro-organisms
      infected person [host] or other source
   Method of transmission
      hands, instruments, clothing, coughing,
       sneezing, dust etc.
   Point of entry
      orifices, mucous membranes, skin
   Susceptible host
      low resistance to infection (May, 2000)
HAI - common bacteria
   Staphylococci - wound, respiratory and
    gastro-intestinal infections
   Eshericia coli - wound and urinary tract
    infections
   Salmonella - food poisoning
   Streptococci - wound, throat and urinary
    tract infections
   Proteus - wound and urinary tract
    infections (Peto, 1998)
HAI - common viruses
   Hepatitis A - infectious hepatitis
   Hepatitis B - serum hepatitis
   Human immunodeficiency virus [HIV] -
    acquired immunodeficiency syndrome
    [AIDS] (Peto, 1998)
   Common types of HAI
        Other            UTI
        27%              23%




Blood
 6%
         Skin                  Lower

         10%    Wound      respiratory
                11%            23%

(May, 2000)
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
Universal precautions
   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
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
Hand washing – areas missed
               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.
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)
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)
Aseptic technique
   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)
Isolation
   Single room or group
   Source or protective
   Source - isolation of infected patient
     mainly to prevent airborne transmission
      via respiratory droplets
     respiratory MRSA, pulmonary
      tuberculosis
   Protective - isolation of immuno-
    suppressed patient (May, 2000)
   Significant psychological effects (Davies
    et al, 1999)
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)
Linen handling and disposal
   Bedmaking and linen changing techniques
   Gloves and apron - handling contaminated
    linen
   Appropriate laundry bags
   Avoid contamination of clean linen
   Hazards of on-site ward-based laundering
   NHS Executive guidelines (1995)
   Follow local policy (May, 2000)
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)
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)
Environmental cleaning
   Recent concern regarding poor hygiene in
    hospital environments (NHSE, 1999)
   Some pathogens survive for long periods in
    dust, debris and dirt
   Poor hygiene standards - hazardous to
    patients and staff (May, 2000)
   Report poor hygiene to Domestic Services
    (UKCC, 1992)
   “Hospitals should do the sick no harm”
    (Nightingale, 1854)
Risk assessment
   No risk of contact/splashing with
    blood/body fluids - PPE not required
   Low or moderate risk of contact/splashing
    - wear gloves and plastic apron
   High risk of contact/splashing - wear
    gloves, plastic apron, gown, eye/face
    protection (Rcn, 1995)
Body fluids
   Cerebrospinal fluid, peritoneal fluid, pleural
    fluid, synovial fluid, amniotic fluid, semen,
    vaginal secretions, and
   Any other fluid containing visible blood e.g.,
    urine, faeces (Rcn, 1995)
Cost of HAI
   Direct cost to NHS for:
      extended hospital stay, extra resources, extra
       treatment, extra equipment, and extra
       community care costs if discharged needing
       follow-up
   Direct cost to patient/family for:
      pain and scarring, extended stay away from
       family, working days lost, family income loss,
       financial strain - increased visiting etc,
       increased morbidity, increased mortality
       (ICNA, 1998)
Summary
   Ignaz Semmelweis in 1847 demonstrated that
    washing hands saves lives
   Research indicates that 10% of patients
    develop HAI costing the NHS £1 billion and
    20,000 deaths per year
   Old bacteria are causing new problems
   New viral and prion diseases are causing new
    problems
   Reluctance to wash hands still the single most
    important cause of HAI (ICNA, 1998)
   Growing concern about poor hospital hygiene
Core references
   Davies, H. and Rees, J. (2000) Psychological effects of
    isolation nursing (1): mood disturbance. Nursing Standard.
    14, 28, 35-38.
   May, D. (2000) Infection control. Nursing Standard. 14, 28.
    51-57.
   ICNA (1998) Guidelines for hand hygiene. Belper: ICNA.
   NHS Executive (1995) Hospital laundry arrangements for
    used and infected linen - HSG (95) 18. London: DoH.
   Nightingale, F. (1854) Notes on nursing. Edinburgh: Churchill
    Livingstone
   Peto, R. (1998) “Infection control”, In: Mallik, M., Hall, C. and
    Howard, D. (eds) Nursing knowledge and practice - a decision
    making approach. London: Bailliere Tindall.
   Rcn (1995) Infection control in hospitals. London: Rcn.
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
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