Infect ion Control in Neonatology PP

Information about Infect ion Control in Neonatology PP

Published on July 18, 2014

Author: anjumhashmi61

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Infection Control in Neonatology Units: Infection Control in Neonatology Units Dr Anjum Hashmi, MBBS,CCS(USA),MPH Infection Prevention & Control Director, Director Employee's Health, Advisor Quality Management Department East Najran Hospital Najran, Saudi Arabia PowerPoint Presentation: PIONEERS IN INFECTION CONTROL 1815 - 1865 Childbed Fever caused by physicians & medical students washing hands with lime water reduced death rates From 18% to <2% Finding not accepted By peers 1827 - 1912 Using carbolic acid reduced Nosocomial infections in the Glasgow General Hospital Findings well accepted by peers Joseph Lister Ignaz Semmelweiss 400 - 800BC • Wrote a Treatise on surgery • Used fumigation techniques • Clip nails and hair Clean and flamed surgical instruments Sushrutha Considered the Father of Surgery Father of Modern Surgery TYPES OF INFECTIONS: TYPES OF INFECTIONS Patient may acquire infection before admission to an hospital known as Community acquired infection . Patient may get infected inside the hospital known as Nosocomial infection/Healthcare Associated Infection (HAIs) . They include: 1) Infections not present nor incubating at time of admission 2) Infections that appear more than 48 hours after admission 3) Infections acquired in the hospital but appear after discharge 4) Occupational infections among staff PowerPoint Presentation: 1 : 20 Gets an infection PowerPoint Presentation: Of those infected  1 in 20 will die  PowerPoint Presentation: Risk of Death is 1:400 from a HAI X PREVALENCE OF HAIs: PREVALENCE OF HAIs Developed countries: Even with sophisticated treatments and technologies, HAIs continues to account for complications in 5-10% of admissions in acute-care hospitals. HAIs are the 4th leading cause of death in the United States today Developing countries: The impact of HAIs is far greater, prevalence studies report hospital-wide infection rates usually higher than 15%. In developing countries, over 4000 children die of HAIs every day. (WHO 2013) PREVALENCE OF HAIs IN NEONATES: PREVALENCE OF HAIs IN NEONATES The rates of bloodstream infections among neonates in developing countries are 3–20 times higher than those reported in developed countries. In developing countries, approximately one-half of patients in neonatal ICUs (NICUs) acquire infections, and more than 52% of affected patients die. Zaidi AKM, Huskins WC, Thaver D, Bhutta ZA, Abbas Z, Goldmann DA. Hospital-acquired neonatal infections in developing countries. Lancet 2005; 365:1175–88. Editorial Commentary • CID 2009:48 CHAIN OF INFECTION: CHAIN OF INFECTION AIM OF INFECTION CONTROL: AIM OF INFECTION CONTROL Disease transmission can be prevented by breaking one or more of the links in the chain of transmission. Basic infection control measures, based on reducing the risk of transmission of pathogens from known, or unknown source. BASICS OF INFECTION CONTROL: BASICS OF INFECTION CONTROL Hospital Infection Control policies and procedures are applied to prevent spread of infection in hospital. Prevention of HAIs is the responsibility of all individuals and services providers of the healthcare setting. To practice good asepsis, one should know: what is dirty, what is clean, what is sterile and how to keep them separate. INFECTION CONTROL PRECAUTIONS: INFECTION CONTROL PRECAUTIONS Standard Precautions Should be applied for ALL patients Transmission-based Precautions * Contact Droplet Airborne *Transmission-based precautions are often used empirically, according to the clinical syndrome and the likely etiological agent POLICIES FOR INFECTION CONTROL IN NEONATOLOGY : POLICIES FOR INFECTION CONTROL IN NEONATOLOGY All Neonatal Care Units staff shall be familiar with the infection control practices that minimized the infection risk in the staff and patients. Strict Hand Hygiene compliance according to WHO 5 moments of hand hygiene. Invasive procedure shall be used cautiously and with appropriate aseptic technique. Handling of neonates shall be minimized. Equipment and supplies should not be shared between infants. Visitor management. PowerPoint Presentation: HAND HYGIENE The Carriers of Top Ten Infectious Diseases Germs : The Carriers of Top Ten Infectious Diseases Germs In US 20,000 cases of HAIs are directly related to poor hand hygiene annually . PowerPoint Presentation: Ignaz Semmelweis 1815 - 1865 Hand Hygiene – Not a New Concept Hungarian obstetrician, Ignaz Semmelweis is considered the father of infection control. He noted that in his ward up to 18% of women died due to puerperal infections K/A “Childbed Fever ” after delivery but death rate was less in home delivery cases. He also noted that doctors & medical students did not wash their hands between patie nts & after autopsies'. Hand Hygiene – Not a New Concept : Hand Hygiene – Not a New Concept Maternal Mortality due to Postpartum Infection General Hospital, Vienna, Austria, 1841-1850 0 2 4 6 8 10 12 14 16 18 1841 1842 1843 1844 1845 1946 1847 1848 1849 1850 Maternal Mortality (%) MD's Midwives Semmelweis’ Hand Hygiene Intervention He enforced hand washing with lime water before & after patients contact, and the mortality rate in his ward dropped to 1-2%. PowerPoint Presentation: Hand hygiene is the single most effective measure to reduce health care-associated infections PowerPoint Presentation: There are five steps in Hand transmission Presence of Germs Transmission to Hands Survival Germs on Hands Defective Hand Hygiene Cross Transmission of Germs Hand Transmission PowerPoint Presentation: Hand Transmission: Step 1 Nearly 1 million skin squames cells containing viable germs sheds daily from normal skin. Patient immediate surroundings (bed linen, furniture, objects) become contaminated (especially by staphylococci and enterococci). Germs present on patients skin and environmental surfaces The Lancet Infectious Diseases 2006 PowerPoint Presentation: Hand Transmission: Step 2 Nurses can contaminate hands with 100-1,000 CFU of Klebsiella spp . during “clean” activities (lifting patients, taking the patient's pulse, blood pressure, or oral temperature). 15% of nurses working in an isolation unit carried a median of 10,000 CFU of S. aureus on their hands. Germ transfer on health-care workers’ hands The Lancet Infectious Diseases 2006 PowerPoint Presentation: Hand Transmission: Step 3 Following contact with patients and/or contaminated environment, germs can survive on hands for differing lengths of time (2-60 minutes) In the absence of hand hygiene, the longer the duration of care, the higher the degree of hand contamination Germs survival on hands The Lancet Infectious Diseases 2006 PowerPoint Presentation: Hand Transmission: Step 4 Insufficient amount of soap and/or insufficient duration of hand hygiene leads to poor hand decontamination. Use of alcohol hand rub has been proven more effective for visibly clean hands. The Lancet Infectious Diseases 2006 Defective hand cleansing TYPES OF HAND HYGIENE: TYPES OF HAND HYGIENE Routine hand hygiene: Washing hands with ordinary soap and warm water for at least 40-60 seconds , then drying with a disposable paper towel. (CDC 2005) Alcohol-based hand rub 20-30 Sec Can be used instead of hand washing, if hands are not visibly soiled. (CDC, 2005) TYPES OF HAND HYGIENE: TYPES OF HAND HYGIENE Antiseptic hand wash : An adequate volume of antiseptic soap should be applied to wet skin for at least 60 seconds, and then rinsed and dry hands with a disposable paper towel. (CDC, 2005) TYPES OF HAND HYGIENE: TYPES OF HAND HYGIENE Surgical hand antisepsis should be performed prior to all surgical procedures, with the aim of removing all transient flora and substantially reducing resident flora. Duration of pre-operative surgical scrub varies between 3 and 5 minutes, as per manufacturers recommended guidelines. (CDC, 2005) The antiseptic agent used must provide broad-spectrum microbiocidal activity, act rapidly, and persist on the skin over several hours, and ideally also provide a cumulative effect after repeated use. TYPES OF HAND HYGIENE: TYPES OF HAND HYGIENE Surgical hand antisepsis should be performed prior to all surgical procedures, with the aim of removing all transient flora and substantially reducing resident flora. Duration of pre-operative surgical scrub varies between 3 and 5 minutes, as per manufacturers recommended guidelines. (CDC, 2005) The antiseptic agent used must provide broad-spectrum microbiocidal activity, act rapidly, and persist on the skin over several hours, and ideally also provide a cumulative effect after repeated use. PowerPoint Presentation: THE 5 STEPS OF HAND TRANSMISSION Pittet D et al, Lancet Infect Dis, Oct 2006 PowerPoint Presentation: 5 MOMENTS FOR HAND HYGIENE Clean hands before touching a patient! To protect the patient against harmful germs carried on HCW hands! Clean hands immediately after an exposure risk to body fluids and after glove removal)! To protect HCW and the health-care environment from harmful germs! Clean hands immediately before an aseptic task! To protect the patient against harmful germs, including the patient’s own one! Clean hands after touching a patient and immediate surroundings, when leaving the patient’s side! To protect HCW and the health-care environment from harmful germs! Clean hands after touching any object or furniture in the patient’s immediate surroundings, when leaving-even if the patient has not been touched! To protect HCW and the health-care environment from harmful germs! PowerPoint Presentation: The Main Examples of this Indication During Everyday Practice of Health Care? Some examples may be: Shaking hands, Helping a patient to move around, Cleaning & washing of patients, Taking pulse, blood pressure, chest auscultation, abdominal palpation PowerPoint Presentation: Some examples may be: Suction of secretion Skin lesion care, Wound dressing, Catheter insertion, Opening a vascular access system or a draining system Preparation of medication/dressing sets. The Main Examples of this Indication During Everyday Practice of Health Care? PowerPoint Presentation: Some examples may be: oral/dental care, giving eye drops, secretion aspiration Skin lesion care, wound dressing, subcutaneous injection Drawing and manipulating any fluid sample, opening a draining system, Endotracheal tube insertion and removal Cleaning urines, faeces, vomit, handling waste (bandages, napkin, incontinence pads), Cleaning of contaminated and visibly soiled material or areas (lavatories, medical or surgical instruments ) The Main Examples of this Indication During Everyday Practice of Health Care? PowerPoint Presentation: Some examples may be: Shaking hands, Helping a patient to move around, Cleaning & washing of patients, Taking pulse, blood pressure, chest auscultation, abdominal palpation The Main Examples of this Indication During Everyday Practice of Health Care? PowerPoint Presentation: Some examples may be: Changing bed linen Monitoring alarm Holding a bed rail Clearing the bedside table The Main Examples of this Indication During Everyday Practice of Health Care? PowerPoint Presentation: To effectively reduce germs on hands, HANDWASHING must last 40-60 secs and should be performed by following all steps illustrated in figure. PowerPoint Presentation: Gloves are not substitute hand washing, it must be done before putting on gloves and after their removal. FEW FACTS: FEW FACTS A surface as small as a pinhead may contain up to 10 million bacteria. Bacteria can double their number in 20 minutes. We can eliminate 90% of germs through proper hand washing. Wet hands spread 60,400 bacteria , while dry hand can only spread 200 . Residual moisture left on improperly dried hands is the key factor for Bacterial Contamination & Transmission. Thus drying of hands is a key factor in reducing the risk of infection and key part of hand hygiene. PowerPoint Presentation: To effectively reduce germs on hands, ALCOHAL HANDRUBBING must last for 20-30 secs & should be performed by following all steps illustrated in figure. Take 2cc of gel, as less amount dries within 15 secs which is non compliance PowerPoint Presentation: REMEMBER PowerPoint Presentation: I hope you washed your HANDS PowerPoint Presentation: PROCEDURES USED NEONATOLOGY UNITS Techniques Used for Infection Control : Techniques Used for Infection Control Clean Technique Aseptic Technique Sterile Technique All these techniques includes: 1. HCW 2. Patient 3. Environment 4. Instrument / Equipment CLEAN TECHNIQUE : CLEAN TECHNIQUE Clean technique is used for routine patient care procedures; e.g., patient exam, taking pulse temperature, BP, feeding, social touch . 1. HCW should use routine hand wash / Alcohol hand rub before & after patient contact. No need of developing barrier between HCW & patient (CDC & WHO). 2. No skin preparation as patient skin is intact. 3. Environment should be clean. 4. Instrument / Equipment should cleaned or disinfected by low level disinfectant. ASEPTIC TECHNIQUE : ASEPTIC TECHNIQUE Medical Asepsis is a set of specific practices and procedures done under carefully controlled conditions mostly out side operation theater, e.g., IM/IV injections. 1. HCW should use antiseptic soap for hand wash / Alcohol hand rub before & after patient contact. Barrier between HCW hand & patient should be created by using gloves (Non-sterile (CDC)/ sterile). 2. Patient skin needs disinfection by short acting disinfectant like alcohol. 3. Environment should be clean and disinfected. 4. Instrument / Equipment should disinfected by high level disinfectant or sterile. STERILE TECHNIQUE : STERILE TECHNIQUE Surgical Asepsis is used in procedures designed to prevent bloodstream infection & surgical site infection, e.g., insertion of umbilical line, PICC, Central line, surgeries. 1. HCW should use surgical scrub with antiseptic hand wash solution / Avaguard ( Chlorohexadine 1% w/w in 61% w/w alcohol) hand rub lotion. Barrier b/w HCW & pt created by using sterile PPE. 2. Patient skin needs disinfection by long acting disinfectant like Chlorohexadine, Pyodine etc. 3. Environment: Sterile field should be created. 4. Instruments / Equipments should sterile. ASEPTIC NEONATAL CARE PRACTICES : ASEPTIC NEONATAL CARE PRACTICES Peripheral Venous Catheter ( PVC) Insertion: IV Therapy: Preparation of IV fluids: IV Therapy - Umbilical Catheters: Administration of IV medications/drugs PERIPHERAL VENOUS CATHETER (PVC) INSERTION: PERIPHERAL VENOUS CATHETER (PVC) INSERTION Do aseptic hand wash. Wear sterile gloves Disinfect the skin : Clean 5 cm of the skin at the site, working from inside to outwards, with 2% chlorhexidine / 70% alcohol swab with friction for at least 60 seconds. Leave the site to dry for 30 sec. i ) Do not re-palpate the vein once the skin has been cleaned. ii) Use no-touch technique. IV THERAPY & PREPARATION OF IV FLUIDS : Use aseptic technique. Establish a specific area for preparation of medications and IV fluids. This area should not be used to store / place any biologic material (e.g., blood, milk formula etc.). All prepared fluids store in fridge at 2-8 C ( Portion of fluid which is not used should to be disposed after 24 hours max.). IV THERAPY & PREPARATION OF IV FLUIDS ADMINISTRATION OF IV MEDICATIONS : ADMINISTRATION OF IV MEDICATIONS Every step must follow strict aseptic techniques Maintain a closed system at all times. Do not mix medications together. If medications are not compatible with IV fluid, do the following procedure : Stop the IV fluid first Flush the cannula with saline solution Infuse the medication Flush again If needed infuse the second medication and flush again. Restart the routine IV fluid. IV THERAPY - UMBILICAL CATHETERS : IV THERAPY - UMBILICAL CATHETERS Insertion of umbilical catheter: Umbilical catheters should be inserted using sterile techniques. Replacement of catheters: Replace umbilical venous catheters only if the catheter site is infected. Remove and do not replace umbilical artery catheters if any signs of CRBSI, vascular insufficiency, or thrombosis are present. Catheter-site care: Clean the site with an antiseptic before catheter insertion. Do not use topical antibiotic ointment or creams on umbilical catheter insertion sites. Umbilical venous catheter can be used up to 14 days if managed aseptically. INFANT FEEDING MATERNAL BREAST MILK : Expression of breast milk may be necessary when a sick infant is unable to suck. Breast milk shall be collected and stored aseptically. Hands shall be washed with an antiseptic and the milk shall be expressed into sterile containers. All breast pump components in contact with milk should be washed with hot soapy water after each use and disinfected daily. Milk must be stored in a refrigerator for no more than 48 hours. INFANT FEEDING MATERNAL BREAST MILK PowerPoint Presentation: INFECTION CONTROL PRECAUTIONS IN NEONATOLOGY UNITS BARRIER PRECAUTIONS : BARRIER PRECAUTIONS Gloves : Single-use gloves are recommended during all patient contacts (especially with septic neonates) Indication for wearing gloves: Infants with infectious diarrhea, draining skin lesions, purulent conjunctivitis, infection with rotavirus, hepatitis A, or enterovirus. Care of infants with respiratory viral infections in order to reduce the risk of accidental self-inoculation. Wear sterile gloves before performing invasive procedures and IV fluid preparation. Single use gloves are recommended before any patient’s contact. Change gloves between patients or if gloves are visibly soiled or contaminated even when handling the same patient. BARRIER PRECAUTIONS : BARRIER PRECAUTIONS Gowns: A gown protects the infant from contact with the wearer’s clothing and prevents contamination of the healthcare worker’s exposed skin with the infant’s flora. A gown shall be worn if a newborn is to be handled outside the incubator where direct contact is expected and invasive procedures are done. A single gown shall be used for one baby. Gowns are recommended for contacts with infants with certain infections like MRSA. PREVENTION OF TRANSMISSION OF INFECTIONS BETWEEN NEWBORNS : Newborn delivered in same hospital is admitted in MAIN-NURSERY/ MAIN NICU. Newborn delivered in same hospita l is admitted to ISO-NURSERY or ISO- NICU . If Newborn with clinical or laboratory evidence of infection. Newborn delivered outside is admitted to ISO-NURSERY or ISO- NICU in following situations: Newborn admitted from ER, OPD. 2. Newborn referred from other hospital. In this case the newborn must be screened for MRSA. PREVENTION OF TRANSMISSION OF INFECTIONS BETWEEN NEWBORNS SINGLE ROOM ISOLATION : SINGLE ROOM ISOLATION To prevent the spread of communicable diseases. Newborn with documented or suspected infection with communicable or epidemiologically important pathogen . 1 - Infants of mothers with parental varicella or varicella , measles, tuberculosis ( Airborne Precaution). 2 - Infants with infections with droplet transmission, such as, mumps, meningitis ( Droplet Precautions). 3 - Infant with MRSA, MDRO (Contact Precaution). VISITORS MANAGEMENT : No visiting time. Visitors should be treated on a individual basis. View babies through the viewing box. If mandatory to enter in the unit allow only parents after rounds with hand hygiene protocol and use protective clothing. VISITORS MANAGEMENT STAFFING NORMS: STAFFING NORMS Adequate staff is mandatory to allow for hand washing between patients’ contact . Normal nursery - staffing ratio is: one professional nurse to every 6-8 infants. Intermediate care nursery - staffing ratio is: one professional nurse for ever 2-3 patients. NICU - one professional nurse for every 1-2 patients. LINEN HANDLING : LINEN HANDLING Ensure that linen handling policy is adhered to, to prevent cross-infection. Enough clean linen must be made available Clean linen should be transported in covered carts or laundry bags. Soiled linen should be discarded into leak proof yellow bags, taken to the laundry twice daily. Nappy changes should be done wearing disposable rubber gloves to prevent heavy contamination and transient colonization of the hands. WASTE DISPOSAL: WASTE DISPOSAL Handling and processing infectious waste Waste must be placed in color coded, leakage proof bags, collected with barrier precautions like gloves. Soiled diapers and medical waste should be collected 3-6 hourly. Proper disposal of sharps to be practiced to prevent needle stick injuries. NEONATOLOGY UNIT EMPLOYEE HEALTH: NEONATOLOGY UNIT EMPLOYEE HEALTH Personnel allocated to work in neonatology should be immune to rubella, measles, polio and chicken pox. HBV and yearly influenza vaccination should be offered. Proper PPE should be readily available for use, when blood splashes and body fluids spillages are anticipated. Infection safety & sharp disposal to be practiced to prevent needle stick injuries. PowerPoint Presentation: THANK YOU Email: [email protected] Solar Filament Eruption Creates 'Canyon of Fire‘ on Sept 2013

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