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					                  Infection Control

   Basic Medical Asepsis                  Gerontologic
                                            Conciderations
   Standard Precautions                   Management Guidlines


   Isolation                              Critical Thinking




                  Dr. Aidah Alkaissi Division of
                Anaesthesiology & Intensive Care
                  Linköping University Sweden
                       Learning Objectives

   Describe & draw the six steps in the chain of infection
   Explain what is meant by the body´s natural defenses
   List and describe conditions that predispose client to infection
   Describe what is meant by the term nosocomial infection and disscuss
    one intervention that will help to prevent it
   List the major organisms responsible for nosocomial infections state
    the main purpose of handwashing
   Define the terms surgical asepsis and medical asepsis
   Describe the modes of transmission of HIV
   List precaution principles and explain their main purpose
                           between the first and second tier of
    Describe the difference Dr. Aidah Alkaissi Division of
    precautions           Anaesthesiology & Intensive Care
                          Linköping University Sweden
                     Chain of Infection

   For an infection to occur a chain of events must take
    place
   If the chain is broken through the implementation of
    infection control measures, the infection is less likely
    to occur



                       Dr. Aidah Alkaissi Division of
                     Anaesthesiology & Intensive Care
                       Linköping University Sweden
       The chain of infection involves six
       steps


   Infection Agent (Microorganism): whether the
    microroganism is capable of producing an infection
    depends on a number of circumstances
   The virulence and number of organisms present
   The susceptibility of the host
   The existence of a portal of entry and the affinity of
    the host to harbor the microorganism

                       Dr. Aidah Alkaissi Division of
                     Anaesthesiology & Intensive Care
                       Linköping University Sweden
        The chain of infection involves six
        steps- Reservoir- Portal of Exit
   Reservoir must provide a favorable environment for growth
    and multiplication of the microorganism
    These reservoirs include the respiratory, gastrointestinal,
    reproductive and urinary tract & blood
   Portal of Exit which allows the microorganism to move from
    the reservoir to the host . The portal of exit is directly
    associated with the reservoir. For example: if the resrvoir is
    the respiratory tract, the portal of exit is through sneezing,
    coughing , breathing or talking. If the reservoir is blood, the
    portal of exit is through an open wound, needle puncture, or
    nonintact skin surface.
                          Dr. Aidah Alkaissi Division of
                        Anaesthesiology & Intensive Care
                          Linköping University Sweden
           The chain of infection involves six
              steps- Mode of Transmission

   Mode of Transmission There are five routes of transmission.
    The three primary routes are contact, droplet, and air borne.
    Too lesser routes are common vehicle(transmission by
    contaminated items such as food, water, devices, or
    equipment) and vector borne ( (transmitted by vectors such as
    mosquitoes fleas, rats)
    –   Contact transmission: the most frequent source of nosocomial
        infection, transmitted via two modes – direct and indirect contact



                              Dr. Aidah Alkaissi Division of
                            Anaesthesiology & Intensive Care
                              Linköping University Sweden
        The chain of infection involves six
           steps Mode of transmission

Direct contact involves a direct transmission, body to body, and
    the physical transfer of microorganisms from one infected
    person to another e.g. Through sexual contact, kissing, touch
 It may occur when a health care worker touches a client, gives
    a client a bath, or performs other care activities
Indirect transmission involves contact with a contaminated
    intermediate object such as a needle, instrument, or dressing
This occurs when contaminated hands are not washed and
    gloves are not changed between clients
                        Dr. Aidah Alkaissi Division of
                      Anaesthesiology & Intensive Care
                        Linköping University Sweden
       The chain of infection involves six
       steps

   Droplet transmission: it occurs when droplets from
    the infected source person are projected a short
    distance to the host´s nasal mucosa , mouth or
    conjunctiva
   These droplets are not suspended in the air, so it is
    not considered airborne transmission


                       Dr. Aidah Alkaissi Division of
                     Anaesthesiology & Intensive Care
                       Linköping University Sweden
         The chain of infection involves six
         steps- Mode of transmission

   Air borne transmision occurs by dissemination either
    small particle nuclei of evaporated droplets or dust
    particles containing the infectious agent
    –   These agent can be dispersed widely by air currents as
        with Legionnaire´s disease & may be inhaled by a
        susceptible host.
    –   These microorganisms include mycobacterium
        tuberculosis, rubeola and varicella viruses

                          Dr. Aidah Alkaissi Division of
                        Anaesthesiology & Intensive Care
                          Linköping University Sweden
        The chain of infection involves six
        steps- Portal of Entry

   The most effective barrier to transmission of microorganisms
    is an intact skin
   For an infection to occur it must have a means of entering the
    body
   A disruption in the integrity of the skin provides such a port of
    entry for microorganisms
   Microorganisms also enter the body the same way they leave
    the body. The respiratory system provides a vailable portal of
    both exit and entry
                          Dr. Aidah Alkaissi Division of
                        Anaesthesiology & Intensive Care
                          Linköping University Sweden
        The chain of infection involves six
        steps- Susceptible Host

   For an infection to occur a susceptible host is needed-
    someone who is ”at risk” this includes the clients who are
    immunesuppressed, fatigue, stressed, anemic, not
    immunized, poorly nourished,
   Those who have underlying diseases
   Hospitalized client with wounds, catheters, IVs are at high
    risk for developing infections.
   Clients who require invasive procedures, blood specimen
    collections, & surgery are in the high risk category
                         Dr. Aidah Alkaissi Division of
                       Anaesthesiology & Intensive Care
                         Linköping University Sweden
                  Barriers to infection


 An individual´s ability to resist infection is determined
by the status of the body´s defense mechanisms and
by the persons general health




                      Dr. Aidah Alkaissi Division of
                    Anaesthesiology & Intensive Care
                      Linköping University Sweden
         Factors that contribute to
         susceptibility to infection include
   Altered nutritional status
   Fatigue disease
   Drugs
   Metabolic functions
   Age
    –   Clients with severe underlying diseases are more likely to develop
        nosocomial infections
    –   The body is protected against infection by immunities, by the
        inflammatory process, and by anatomic barriers that include the skin
        and mucous membranes

                             Dr. Aidah Alkaissi Division of
                           Anaesthesiology & Intensive Care
                             Linköping University Sweden
        Barriers to infection

   When the integrity of the skin or mucous membrane is broken,
    both resident and transient flora or bacteria have a direct
    route to the internal tissue of the body
   To prvent the spread of infection the body´s internal defense
    mechanisms mobilize and begin clearing and repairing the
    damage site
   How quickly a wound heals depends on the degree of
    vascularization in the injured area, the location and
    cleanliness of the wound and the degree of tissue damage
                         Dr. Aidah Alkaissi Division of
                       Anaesthesiology & Intensive Care
                         Linköping University Sweden
       Barriers to infection

   The second way the body resists infections is
    through immunity , antitoxins, and vaccines
   Natural immunity is inherited. Accquired immunity
    occurs after an individual has been exposed to a
    disease or infection or has been vaccinated



                      Dr. Aidah Alkaissi Division of
                    Anaesthesiology & Intensive Care
                      Linköping University Sweden
     Barriers to infection

  The third way the body resist infection is through the
   inflammatory process
 Inflammation involves use of metabolic energy
, increased blood flow to the inflamed areas, in many
   cases drainage of inflammatory debris to the external
   environment


                     Dr. Aidah Alkaissi Division of
                   Anaesthesiology & Intensive Care
                     Linköping University Sweden
        Barriers to infection

   When an area becomes inflamed , cells at the site activate the
    plasmin system, the clotting system, the kinin system
   The result of the activation of these system is the release of
    histamine, which creates increase vascular permeability
    around the injured site and the release of chemotoxic agents,
    which summon phagocytes into the vascular and tissue
    spaces
   Phagocytes are W.B.C that combat and prevent infection by
    ingesting harmful microorganism
                         Dr. Aidah Alkaissi Division of
                       Anaesthesiology & Intensive Care
                         Linköping University Sweden
       The body´s natural defences

   Almost any organism can be the cause of a
    significant nosocomial infection
   Some of variables that help determine which
    organism emerges as the pathogen are the virulence
    and number of organism
   The exposure and attachment of the organisms to a
    susceptible sitre and the duration of the client´s
    exposure to infectious challenge
                     Dr. Aidah Alkaissi Division of
                   Anaesthesiology & Intensive Care
                     Linköping University Sweden
       The body´s natural defences
 The following formula illustrates these variables
Dose x virulence / host resistance = infection
Using this formula , the client´s risk factors can be evaluated. the
  inherent health and immunologic status of the client are major
  factors in determining whether an infection occur
 Alterations in the skin barrier include any physiologic break in
  the integrity of the skin
 Intentional breaks are caused by the use of percutaneous
  catheter and needles and by surgical procedures.
  Unintentional causes of skin breakdown include the
  development of presure ulcers and traumatic wounds
                         Dr. Aidah Alkaissi Division of
                       Anaesthesiology & Intensive Care
                         Linköping University Sweden
        Conditions predisposing to
        infection
   Certain conditions and invasive techniques predispose clients
    to infection because the integrity of the skin is broken or the
    illness itself establishes a climate favorable for the infection
    process to occur. Among the most common are surgical
    wounds, changes in the antibacterial immune system or
    alteration in the respiratory tract or genitourinary tract
   Implant such as heart valves, prosthetic grafts, or vascular
    grafts can lead to nosocomial septicemias
   The extensive use of IV therapy in clients has increased
    infections dramatically
                          Dr. Aidah Alkaissi Division of
                        Anaesthesiology & Intensive Care
                          Linköping University Sweden
                     Surgical wounds

   It has been documented that the longer a person is
    hospitalized prior to the surgical procedure the
    greater the risk of postsurgical infection
   Other factors that influence infection rates are
    duration of time in the operating room, time surgery
    is done (between midnight and 8:00 A.M is period of
    greatest risk), whether the client has postsurgical
    drains in place, or if the surgery enters a colonized or
    infected part of the body
                       Dr. Aidah Alkaissi Division of
                     Anaesthesiology & Intensive Care
                       Linköping University Sweden
       Surgical wounds

   It is useful for the nurse to be aware of conditions
    that increase the risk of postoperative infection
   Risk reduction measures include preoperative
    showering with an antiseptic solution, the use of
    depilatory creams or the clipping of hair in lieu of
    shaving the surgical site and keeping the incision site
    covered with a dry sterile dressing

                       Dr. Aidah Alkaissi Division of
                     Anaesthesiology & Intensive Care
                       Linköping University Sweden
       Surgical wounds

    a wet dressing, through osmosis and diffusion ,
    pulls organisms down into the wound from the
    surface. This is particularly important during the first
    45 hours before the wound becomes ”watertight”.
    Research shows that preoperative shaving results in
    disruption of normal flora on the surface of the skin



                       Dr. Aidah Alkaissi Division of
                     Anaesthesiology & Intensive Care
                       Linköping University Sweden
         Antibacterial immune mechanism
   Three categories of abnormalities in antibacterial immune
    mehanism:
    –   those affecting inflammatory responses,
    –   those affecting phagocytic functions and
    –   those affecting opsonins (humoral immunity)
   Anything that interfers with the migration of phagocytic cells to
    the area of contamination or with the physical contact of
    phagocytes and bacteria enhances the development of an
    infection e.g. Deficient blood supplies, the presence of
    ischemia or dead tissue, sutured material, foreign bodies,
    hematomas.
                             Dr. Aidah Alkaissi Division of
                           Anaesthesiology & Intensive Care
                             Linköping University Sweden
       Antibacterial immune mechanism

   Vasopressor agents, radiation injury, uremia, severe
    nutritional deficiencies, and steroid therapy inhibit the
    synthesis of antibodies and other essential proteins
   Clients with severe thermal injuries and severe
    nutritional deficiencies have abnormalities involving
    the number of neutrophils collected at the site of an
    inflammatory response and defects of bacterial
    chemotoxic capacity
                       Dr. Aidah Alkaissi Division of
                     Anaesthesiology & Intensive Care
                       Linköping University Sweden
       Antibacterial immune mechanism

   Client with Hodgkins disease have a specific defect
    in cell-mediated immunity
   Genetic inabilities to synthesize complement
    components or specific antibodies can cause
    abnormalities in opsonins. Burn client may have
    complement inactivated by a circulating substance
    released by the damaged tissue without
    complement, lysis of cells and destruction of bacteria
    cannot take place
                      Dr. Aidah Alkaissi Division of
                    Anaesthesiology & Intensive Care
                      Linköping University Sweden
       Respiratory Tract

   Alteration that facilitat infection include endotracheal
    intubation, tracheostomy, bronchotracheal
    suctioning, & stasis due to poor respiratory excursion
    for client on bed rest
   Catheter placed directly in the trachea can force
    pathogenic microorganisms into the respiratory
    system
   Catheter may damage the mucous lining of the
    respiratory tract
                       Dr. Aidah Alkaissi Division of
                     Anaesthesiology & Intensive Care
                       Linköping University Sweden
                   Genitourinary tract

   Instrumentation including catheterization of the
    bladder and complicated obstetric delivery after
    prolonges confinement in bed are two procedures
    that introduce potentially pathogenic bacteria into the
    genitourinary tract
   Acute urinary tract infection and pyelonephritis occur
    after the use of a catheter or cystoscope

                       Dr. Aidah Alkaissi Division of
                     Anaesthesiology & Intensive Care
                       Linköping University Sweden
                          Invasive devices

   Nosocomial septicemias occur as a result of significant
    alterations in normal host defences
    –   Primary infection caused by direct introduction of microorganisms
        into the bloodstream
    –   Secondary arising from an infection at another site such as the
        urinary tract
    –   The most common site for a nosocomial infection is the urinary tract
    –   The use of IV therapy greatly increases the risk of introducing
        harmful microorganisms


                           Dr. Aidah Alkaissi Division of
                         Anaesthesiology & Intensive Care
                           Linköping University Sweden
                     Invasive devices

–   Septicemia may be caused by introduction of
    microorganisms from contaminated fluids, infected
    venipuncture sites, foci of septic thrombophlebitis as
    complication of using an indwelling IV catheter
–   Infusion related sepsis is associated with contaminated
    infusion fluid which may be contaminated either during
    manufacturing (intrensic contamination) or during hospital
    use (extrensic contamination)


                      Dr. Aidah Alkaissi Division of
                    Anaesthesiology & Intensive Care
                      Linköping University Sweden
                         Venipuncture Sites
   The wounds made by a percutaneous stick at the venipuncture site may
    become colonized or infected
   This opening provides a reservoir for bacteria that could move along the
    catheter into the bloodstream
   Site infections can be reduced by several methods:
     – Selecting a catheter appropriate to the size of the vein
     – Avoiding sites near joints
     – The performance of proper site preparation
     – Maintaining regimen for site care
     – Changing the site every 48-72 hours as well as maintaining a closed
        system of therapy

                             Dr. Aidah Alkaissi Division of
                           Anaesthesiology & Intensive Care
                             Linköping University Sweden
        Total Parenteral Nutrition Therapy

   Means acheiving an anabolic state in clients who would
    otherwise be unable to maintain normal nitrogen balance
   The hypertonic solution used with these client supports the
    growth of a wide variety of organisms especially fungus
   Peripheral inserted central catheter lines may not be changed
    for months
   Meticulous site care must be done at least every three days to
    preserve the site and aseptic technique used when changing
    solution, tubing, dressings and filters
                         Dr. Aidah Alkaissi Division of
                       Anaesthesiology & Intensive Care
                         Linköping University Sweden
             Implanted prosthetic devices

   Include artificial cardiac valves, synthetic vascular
    grafts, orthopedic prosthetic joints, neurosurgical
    shunts, cerebro spinal fluid pressure monitoring
    devices
   If the infection is not controlled, removal and
    replacement of the prosthesis is indicated


                       Dr. Aidah Alkaissi Division of
                     Anaesthesiology & Intensive Care
                       Linköping University Sweden
                 Nosocomial infections

   Are infections that are acquired while the client is in
    the hospital
   Infections that were not present or incubating at the
    time of admission
   Handwashing is the single most importan
    intervention to prevent these infections


                       Dr. Aidah Alkaissi Division of
                     Anaesthesiology & Intensive Care
                       Linköping University Sweden
         Nosocomial infections

   Three major organisms responsible for the majority
    of nosocomial infections
    –   Clostridium difficile
    –   Methicillin-resistant staphylococcus aureus (MRSA)
    –   Vancomycin-resistant enterococcus (VRE)




                         Dr. Aidah Alkaissi Division of
                       Anaesthesiology & Intensive Care
                         Linköping University Sweden
                     Nosocomial infections

   The most common organisms
    –   C.difficile is an anaerobic
    –   Gram-positive
    –   Spore-formig bacillus associated with infectious
        diarrhea(CDAD)
    –   20-40% of hospitalized clients become colonized within a
        few days of entering the hospital, because it is often
        resistant to antimicrobial therapy, it is able to proliferate in
        the hospital setting
                            Dr. Aidah Alkaissi Division of
                          Anaesthesiology & Intensive Care
                            Linköping University Sweden
                  Nosocomial pneumonia
   Affecting 40% of all critically ill or immunosuppressed clients
    cause is gram-positive staphylococcus that is methicillin
    resistant
   Occurs in clients who have invasive procedures such as
    intravenous or respiratory therapy treatment or surgical
    procedures
   Health care personnel easily transmit MRSA to clients
    because it frequently colonizes skin
   Vancomycin, the drug choice to treat MRSA, is losing its
    effectiveness as a treatment
                          Dr. Aidah Alkaissi Division of
                        Anaesthesiology & Intensive Care
                          Linköping University Sweden
                 Vancomycin-resistant
                  enterococcus (VRE)

   A gram positive bacterium
   Normally found in flora of the gastrintestinal tract
   When this bacterium mutated and became resistant
    to common antimicrobial therapies, it became a
    major cause of nosocomial infections in the hospital
    setting
   Zyvox is the drug choics for VRE and MRSA

                      Dr. Aidah Alkaissi Division of
                    Anaesthesiology & Intensive Care
                      Linköping University Sweden
                         Standard precaution

   1985, universal precautions were instituted as a result of the
    human immunodeficiency virus (HIV)
    –   Blood and body fluid precautions were practiced on all clients
        regardless of their potential infectious state
 1987, body substance isolation (BSI)was proposed
The intent to isolate all moist and potentially infectious body
    –    substances (blood, feces, urine, sputum, saliva, wound drainage,
        &other body fluids) from all the clients, regardless of their infections
        status, primarily through the use of gloves

                               Dr. Aidah Alkaissi Division of
                             Anaesthesiology & Intensive Care
                               Linköping University Sweden
                   Standard precaution

    1994, the CDC drafted new guidlines , contain two
    tiers of precautions
   The first tier, standard precautions, blends the major
    features of universal precautions (blood and body
    fluids precautions)and body substance isolation into
    a single set of precautions to be used for the care of
    all clients in hospitals regardless of their diagnosis or
    presumed infection status
                       Dr. Aidah Alkaissi Division of
                     Anaesthesiology & Intensive Care
                       Linköping University Sweden
                Standard precaution

   The new standard precautions apply to blood all
    body fluids, secretions, and excretions, whether or
    not they contain visible blood, non intact skin, and
    mucous membranes
   These precautions are designed to reduce the risk
    of transmission of both recognized and
    unrecognized sources of infection in hospitals

                     Dr. Aidah Alkaissi Division of
                   Anaesthesiology & Intensive Care
                     Linköping University Sweden
                  Standard precaution

   As a result of the new category of standard
    precautions, clients with diseases or conditions that
    previously required category-specific or disease
    specific precautions are now covered under this
    category and do not require additional precautions




                       Dr. Aidah Alkaissi Division of
                     Anaesthesiology & Intensive Care
                       Linköping University Sweden
                   Standard precaution

   The second tier, transmission-based precautions is designed
    only for the care of specified clients
   This tier reduces the disease-specific precautions into three
    sets of precautions based on routes of transmission
   These categories are designed for clients documented or
    suspected to be infected or colonized with highly
    transmissible or epidemiologically important pathogens for
    which additional precautions must be used to interrupt
    transmission to other in the hospital
                        Dr. Aidah Alkaissi Division of
                      Anaesthesiology & Intensive Care
                        Linköping University Sweden
              Types of transmission based
                      precautions


   Airborne precautions reduce the risk of airborne transmission
    of infection agents such as measles, varicella, and
    tuberculosis
   Droplet precautions are used to prevent the transmission of
    diseases, such as meningitis, scarlet fever, diphtheria, rubella
    and pertussis
   Contact precaution are used for clients known or susbected to
    have serious illness easily transmitted by direct contact such
    as herpes simplex, staphylococcal infections, hepatitis A
    respiratory syncyntial virus, wound or skin infection
                          Dr. Aidah Alkaissi Division of
                        Anaesthesiology & Intensive Care
                          Linköping University Sweden
                     Fundamental principles
   1. Handwashing
   2. The use of gloves
     – Mask, eye protection and face sheild in which splashes or sprays could
        come in contact with eyes and mucous membrane
     – Gown, should be worn whenever there is a risk of contamination from
        blood , bloody fluids, secretions or excretions
     – Linen, transport soiledlinens in a manner that prevents skin and mucous
        membrane exposure, contamination of clothing and transfer of
        microorganisms to other clients and environment- double-bagging linen
        before taking it to the laundry facility
   3. The proper placement of clients in the hospital to prevent the spread of
    microorganisms to others or to the client
   4. The appropriate use of isolation equipment to prevent the spread of
                                 care workers and other clients
    microorganisms to health Dr. Aidah Alkaissi Division of
                           Anaesthesiology & Intensive Care
                             Linköping University Sweden
              Occupational health and blood-borne
                          pathogens



   Take precautions to prevent injuries caused by needles,
    scalpels or other sharp instruments or devices
   Never recap used needles, purposely bend or break needles
    by hand, remove needles from disposable syringes or other
    handle needles directly
   All such instrument should be placed in puncture-resistant
    containers for disposal
   Mouth pieces, resuscitation bags, or other ventilation devices
    should be used as an alternative to mouth –to mouth
    resuscitation
                         Dr. Aidah Alkaissi Division of
                       Anaesthesiology & Intensive Care
                         Linköping University Sweden
                    Client placement

   Clients who are at risk for contaminating the
    environment or who are unable to maintain
    appropriate hygiene or environmental control should
    be placed in a private room




                      Dr. Aidah Alkaissi Division of
                    Anaesthesiology & Intensive Care
                      Linköping University Sweden
        Guidlines should be considered
        when providing client care

   Health care workers who have open lesions, upper respiratory
    infections, weeping dermatitis should refrain from all direct
    client contact and from handling client care equipment
   Because of the risk of transmission of HIV and hepatitis B
    virus (HBV) frother to fetus, pregnant health workers should
    be especially familiar with and strictly adher to precautions to
    minimize risk of these viruses.
   Currently pregnant health care workers are not known to be at
    greater risk of contracting HIV or HBV than other workers
                          Dr. Aidah Alkaissi Division of
                        Anaesthesiology & Intensive Care
                          Linköping University Sweden
       Health care workers protection

   Statistics from the Centers for Disease Control and
    Prevention (CDC)indicating that more than 800,000
    needle sticks and sharp injuries were being reported
    yearly
   Needles stick injuries caused by hollow-borne
    needles accounted for 86% of all reported
    occupational HIV exposures
   Nurses make up 24% of all the cases of HIV
    infection among health care workers
                      Dr. Aidah Alkaissi Division of
                    Anaesthesiology & Intensive Care
                      Linköping University Sweden
        Health care workers protection

   More than 20 pathogens can be transmitted through
    small amounts of blood
   In addition to HIV and hepatitieB, syphilis, varicella-
    zoster, and hepatitis c can be transmitted vis this route
   Hepatitis B is the most common infectious disease
    transmitted through work-related exposure to blood
   About 5,100 health care workers become infected with
    Hepatitis B each year

                          Dr. Aidah Alkaissi Division of
                        Anaesthesiology & Intensive Care
                          Linköping University Sweden
        Required Immunity Syndrome (AIDS)
           Epidemiology and Modes of
                   transmission

   The statistics are chilling: CDC report from US 2001:
    79,3000
   649,000 are males
   134,845 are females
   8,994 are children under 13
   Estimates are that will be 75 million HIV cases in the top
    five industrial nations by 2010
   Aids the second leading killer of young men 24-44 y
   Aids will be the third most common cause of death in the
    united states
                       Dr. Aidah Alkaissi Division of
                     Anaesthesiology & Intensive Care
                       Linköping University Sweden
Required Immunity Syndrome (AIDS)
Epidemiology and Modes of
transmission

   Aids is the most serious epidemic facing the modern
    world, making knowledge about it and techniques for
    caring for the AIDS client mandatory learning for all
    nurses. No one is immune to AIDS
   The two major risk groups continue to be homosexual
    or bisexual men an IV drug abusers which make up
    over 2/3 of all AIDS cases
   The incidence of female African American cases
    increased significantly among infected heterosexuals
    (11%)
                  Dr. Aidah Alkaissi Division of
                Anaesthesiology & Intensive Care
                  Linköping University Sweden
                                 Definitions
                                   AIDS
   Defined by CDCas an HIV infection in a person with a CD4+
    T-lymphocyte count of less than 200 cells/microliter( L) of
    blood or a CD4 percentage of less than 14
   26 conditions listed in the category C
    –   Cytomegalovirus (CMV) retinitis
    –   Kaposi´s sarcoma
    –   Mycobacterium avium complex (MAC) which includes the M.avium and
        M. Intracellulare organisms
    –   ´M.Kansasii
    –   Mycobacterium tuberculosis
    –   Pnemocytis carinii
    –   Recurrent pneumoniaDr. Aidah Alkaissi Division of
                         Anaesthesiology & Intensive Care
                           Linköping University Sweden
          Health Care Workers`Exposure to
                        HIV
   The average risk for HIV-transmission after a percutancous
    exposure to HIV-infected blood is approximately 0.3% and
    after a mucous membrane exposure is 0.09%
   Risk factors for transmission by skin exposure and fluid or
    tissue exposure has not been quantified
   CDC states 600,000-80,000 needle stick injuries occur each
    year with potential risk of HIV exposure
   Conciderations that influence the use of postexposure
    prophylaxis (PEP) how soon after exposure PEP was begun
    and the believe that the infection can be prevented or
                               the antiretroviral
    improved by the use of Aidah Alkaissi Division of drugs
                           Dr.
                       Anaesthesiology & Intensive Care
                         Linköping University Sweden
                      Exposure definition

   Percutaneous injury, contact of mucous membrane, or
    nonintact skin, or contact with intact skin when the duration of
    contact is prolonged or involves an extensive area, with the
    blood, tissue or other body fluids.
   Body fluids include semen, vaginal secretions, or other body
    fluids contaminated with visible blood (cerebrospinal,
    synovial, pleural, amniotic fluids, peritoneal, pericardial)
   There is no evidence that tears, sweat, nonbloody urine or
    feces transmit HIV
                          Dr. Aidah Alkaissi Division of
                        Anaesthesiology & Intensive Care
                          Linköping University Sweden
A recommendations for PEP

   4-week regimen of two drugs (Zidovudine and
    lamivudine) for most HIV exposures
   An expanded regimen that includes the
    addition of a protease inhibitor (indinavir or
    nelfinavir) is recommended for HIV exposures
    that pose an increased risk of transmission or
    when there is a known or suspected resistance
    to one or more of the antiretroviral agents
    recommended for PEP
                Dr. Aidah Alkaissi Division of
              Anaesthesiology & Intensive Care
                Linköping University Sweden
                            Tuberculosis
   Infectious disease caused by the tubercle bacillus
    Mycobacterium tuberculosis
   The main reservoir for the organism is the human respiratory
    tract
   Transmission occurs between individuals through respiratory
    contact
   The tubercle bacillus enters the respiratory tract on droplets
    transmitted through productive coughing from the infectd
    individual
   Symptoms may occur 4-12 weeks after exposure or may go
    unnoticed for many years Alkaissi Division of
                         Dr. Aidah
                       Anaesthesiology & Intensive Care
                         Linköping University Sweden
                           Tuberculosis
   Active pulmonary tuberculosis has a slow, insidious onset
   The progression of the active disease and symptoms of
    cough, weight loss, fever usually occur within the first two
    years after the infection
   Latent infections which are asymptomatic are not infectious
    and may last a lifetime
   Without RX tuberculosis progresses to other body sites
   Disseminated tuberculosis occurs in many of the body areas ,
    not just the lungs
   The incidence of tuberculosis cases has increased greatly,
                           Dr. AIDS epidemic
    due in large part of the Aidah Alkaissi Division of
                      Anaesthesiology & Intensive Care
                        Linköping University Sweden
                             Tuberculosis

   Immunosuppressed hosts are very vulnerable to the bacillus
   In addition to immunosuppressed individuals , other
    concidered at high risk for infection include alcoholics; IV drug
    abusers, individuals who share a closed environment with the
    infected individual, residents of instituations such as long term
    care , foreign-born individuals from countries with a high
    prevalence of tuberculosis, such as Asia, Latin America,
    Africa, Mexico, the former Soviet Union, low income
    populations who are medically underserved

                          Dr. Aidah Alkaissi Division of
                        Anaesthesiology & Intensive Care
                          Linköping University Sweden
                             Tuberculosis
   Early recognition and treatment of tuberculosis must be
    intiated prompltly and isolation measures instituted to prevent
    the spread of the disease
   The purified protein derivative (PPD) skintest is used to
    quickly identify the infection in the absence of clinical
    stmptoms
   Sputum specimens for AFB and culture and sensitivity and
    chest x-rays are also orderedto rule out TB
   A PPD skin test is read 48-72 hours after the injection
   A positive skin test is indicated by an induration of 5-10 mm at
    the site of injection Dr. Aidah Alkaissi Division of
                        Anaesthesiology & Intensive Care
                          Linköping University Sweden
                             Tuberculosis
   A two step method is now being used, particularly with health
    care workers
   The procedure involves the first PPD to be given and read
    within 48-72 hours
   If the PPD is negative or doubtful the PPD is repeated in one
    week.
   If the client has a positive reaction, he or she is started on a
    prophylaxis regimen
   A client who is known to be HIV positive with a 5 mm or
    larger duration at the site of the PPD injection should be
                           Dr. tuberculosis
    concidered positive for Aidah Alkaissi Division of
                        Anaesthesiology & Intensive Care
                          Linköping University Sweden
                           Viral Hepatitis
   There are six forms of hepatitis, each form differs in regard to
    incubation period, route of transmission, antigenetic
    properties and progression to chronicity
   All forms of hepatitis produce an inflammatory response to the
    liver which is characterized by liver cell necrosis, inflammation
    and cell regeneration
   The three major forms of hepatitis are hepatitis A virus (HAV),
    Hepatitis B Virus (HBV) and Hepatitis C virus (HCV).
   Hepatitis D virus (HDV) is not as common and Hepatitis E
    (HEV) is rare
                          Dr. Aidah a recently
    Hepatitis G Virus (HGV) is Alkaissi Division ofisolated blood-borne
                         Anaesthesiology & needle-sticks and blood
    infectious agent transmitted byIntensive Care
                          Linköping University Sweden
                           Viral Hepatitis
   Hepatitis A (HAV) is spread via the fecal-oral route and sexual
    transmission
   Poor sanitation and handwashing is a major source of
    infection
   Approximately 152,000 infections occur in the United States
    each year. 99% of those infected recover without any serious
    problems
   HAVRIX vaccine is available to prevent HAV
   Once exposed to the infection or as a preventive therapy,
    immune serum globulin is administered intramuscularly
                         Dr. Aidah Alkaissi Division of
                       Anaesthesiology & Intensive Care
                         Linköping University Sweden
                         Viral Hepatitis
   HepatitisB (HBV) is spread through infected blood or body
    fluids and through two nonparenteral routes, sexual contact
    and perinatal transmission
   Contaminated needles, syringes, and blood products are the
    most common mode of transmission
   About 30% of the cases are spread through sexual contact
   140,000 individuals are infected yearly in US
   2-10% of adults become chronically infected with HBV
    following an infection
   HBV is 100 times more infectious than HIV
   HBV vaccine provides active immunity in over 95% of
                           Dr. Aidah Alkaissi Division of
                         Anaesthesiology & Intensive Care
    recipients             Linköping University Sweden
                           Viral Hepatitis
   Hepatitis B immune globulin provides passive immunity to
    individuals who have contact with HBV-contaminated material
   Hepatitis C (HCV) is transmitted primarily by contact with
    contaminated blood and blood products
   85% of those infected with HCV will remain chronically
    infected
   Chronic HCV infection is the main causal factor for nearly one
    third of all liver transplants
   Thre are three types of interferon used to treat HCV
   The CDC recommends the use of standard precautions with
    clients known to have hepatitis Division of
                             Dr. Aidah Alkaissi
                           Anaesthesiology & Intensive Care
                            Linköping maintained
    The precautions should be University Sweden for one week after the
                Severe Acute Respiratory
                   Syndrome (SARS)
   In 2003, there was a multi-country outbreak of a virus
    suspected to be a mutated form of the corona-virus (the
    common cold)
   The specific SARS pathogen is not known
   There is speculation that this new virus has jumped from
    animal to human, setting up the possibility for a world-wide
    pandemic like 1918 swine or spanish flu that infected millions
    of people around the world and killed more than 20 million
   Jumping species from animal to human and being able to
    transmit person to person is the worst possible combination of
    events because it can cause havoc in a non- immune
                          Dr. Aidah Alkaissi Division of
    population          Anaesthesiology & Intensive Care
                        Linköping University Sweden
                Severe Acute Respiratory
                   Syndrome (SARS)
   Because of this potential for disaster, the world Health
    Organization issued a global alert when this corona virus
    rapidly spread to 26 countries
   The primary symptoms of SARS are malaise, aching muscles,
    a persistent fever < 38, dry cough, shortness of breath or
    breath difficulties, normal WBC
   People with these sympyoms who have recently traveled to
    or been in the far east, are adviced to see a doctor
    immediately
   There is only supportive RX including oxygen and ventilatory
    assistance when necessary
                           Dr. Aidah Alkaissi Division of
                      Anaesthesiology & Intensive Care
                        Linköping University Sweden
               Severe Acute Respiratory
                  Syndrome (SARS

   Total infection control precautions are essential to
    prevent transmission
   These would include goggles or glasses to protect
    mucous membranes of the eyes, N95 mask, gown
    and gloves
   Washing hands carefully is essential


                       Dr. Aidah Alkaissi Division of
                     Anaesthesiology & Intensive Care
                       Linköping University Sweden
               What is Biohazard Waste

   Any solid or liquid waste that may present a threat of
    infection
   This could include laboratory waste, blood or blood
    products, body fluids, absorbent material saturated
    with blood or body fluids (either wet or dry), discarded
    sharps, nonabsorbent disposable devices (drains,
    excretions, gloves, urine specimen)

                       Dr. Aidah Alkaissi Division of
                     Anaesthesiology & Intensive Care
                       Linköping University Sweden
             Storage of Biohazard Material
   Must be apprpriately sealed
   May be stored for 30 days
   Time starts when material is placed in the sharps container or
    biohazard bag
   All biohazard waste must be restricted, locked up, or placed in
    a separate storage area
   Must be labeled correctly so that there is a tracking method
    for each bag, container
   Labels should say ”medical waste” and ”biohazard” and be
    dated when the bag was first placed in the area
                         Dr. Aidah Alkaissi Division of
                       Anaesthesiology & Intensive Care
                         Linköping University Sweden
        Human immunodeficiency virus
        (HIV)

   Is a blood-borne infective retrovirus that invades the CD4+ T-
    lymphocyte (immunity cells), dublicates itself by means of that
    cell
   Infection of HIV progresses to AIDS in at least 35% of those
    infected
   Once the client has been diagnosed with HIV, the usual
    approach to care includes evaluation of the immune system
    and classification by CDC grouping (A) asymptomatic, (B) acute
    symptomatic, and (C) AIDS- indicator conditions
                         Dr. Aidah Alkaissi Division of
                       Anaesthesiology & Intensive Care
                         Linköping University Sweden
          Human immunodeficiency virus
                    (HIV)

   Identification and RX of infectious and neoplastic
    complications, initiation of approved antiretroviral
    therapy and concideration of experimental measures
    are included in the evaluation




                      Dr. Aidah Alkaissi Division of
                    Anaesthesiology & Intensive Care
                      Linköping University Sweden
        HIV is transmitted through high-risk
        behaviors or other contact with the
        virus including

   Sexual contact with HIV-infected individuals
   Sharing needles with HIV-infected individuals
   Transfusions of blood or blood products from infected
    individuals (not common today, but new cases are still
    reported)
   Babies who become infected from the mother before or during
    birth, or through breast-feeding
   Contact with contaminated needles, blood, secretions, or
    excretions from an HIV infected client
                        Dr. Aidah Alkaissi Division of
                      Anaesthesiology & Intensive Care
                        Linköping University Sweden
Health Care Workers´Exposure to
              HIV




         Dr. Aidah Alkaissi Division of
       Anaesthesiology & Intensive Care
         Linköping University Sweden

				
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