Professional Documents
Culture Documents
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
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
Contemporary issues
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
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 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
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
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)
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)
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)
Hepatitis A - infectious hepatitis Hepatitis B - serum hepatitis Human immunodeficiency virus [HIV] acquired immunodeficiency syndrome [AIDS] (Peto, 1998)
(May, 2000)
Devised in US in the 1980s in response to growing threat from HIV and hepatitis B Not confined to HIV and hepatitis B Treat ALL patients as a potential biohazard 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
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 immunosuppressed 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)
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)
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
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