1

CARING THE INFECTIOUS PATIENTS

DR.T.V.RAO MD

Florence Nightingale, Notes on Hospitals, 1863

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

Learning Objectives
1. 2. 3.

Recognize patient safety as an important nursing responsibility in global health care systems. Apply required knowledge in preventing and/or minimizing infection. Perform appropriate behaviors required to prevent health care associated infections.

4.

Demonstrate required competence to provide patients with safe care.

Main types of infections

Urinary track infections usually associated with catheters Surgical infections

Blood stream infections associated with the use of an intravascular device Pneumonia associated with ventilators
other sites

Health workers to be alert

Facility

staff remain alert for any patient arriving with symptoms of an active infection (e.g., diarrhoea, rash, respiratory symptoms, draining wounds or skin lesions)

Global Infection Problems

According to WHO (2005),

On average, 8.7% of hospital patients suffer health care-associated infections (HAI). In developed countries: 5-10% In developing countries:
Risk
HAI

of HAI: 2-20 times higher

may affect more than 25% of patients

At any one time, over 1.4 million people worldwide suffer from infections acquired while in hospital.

Infection control in the Hospitals

Infection control and prevention uses a risk management approach to minimise or prevent the transmission of infection. Standard and additional precautions principles and practice are based on the mode of transmission of an infectious agent.

Chain of Infection
Pathogen

Susceptible Host

Reservoir

Portal of Entry
Mode

Portal of Exit

of
Transmission

Why Isolation?.. because transmission is easier to control than the source / host!

Practice basic Protocols with Universal Precautions

Standard

precautions are work practices required for the basic level of infection control. They include good hygiene practices, particularly washing and drying hands before and after patient contact, the use of protective barriers which may include gloves, gowns, plastic aprons, masks, eye shields or goggles, appropriate handling and disposal of sharps and other contaminated or clinical (infectious) waste, and use of aseptic techniques.

What is Infection Control?

Patient to
Worker Visitor Patient

Worker to
Worker Visitor Patient

Visitor to
Worker Visitor Patient

Infectiousness
Patients should be considered infectious if they Are coughing Are undergoing cough-inducing or aerosol-generating procedures, or Have sputum smears positive for acid-fast bacilli and they

Are not receiving therapy

Have just started therapy, or Have poor clinical response to therapy

Infectiousness in Tuberculosis patients

Patients no longer infectious if they meet all of these criteria:

Have completed at least two weeks of directly-observed ATT; and Have had a significant clinical response to therapy and

Have had 3 consecutive negative sputum-smear results;

Retreatment /MDR cases may take longer to convert

The only objective criteria is negative bacteriology

Airborne Precautions

Apply to patients known or suspected to be infected with a pathogen that can be transmitted by airborne route; these include, but are not limited to: Tuberculosis Measles

Chickenpox (until lesions are crusted over)

Localized (in immunocompromised patient) or disseminated herpes zoster (until lesions are crusted over)

Fate of Droplets
Organisms Liberated Talking 0-200 Coughing 0-3500 Sneezing 4500-1,000,000

Droplets can remain suspended in the air for hours.

Droplet Precautions

Apply to patients known or suspected to be infected with a pathogen that can be transmitted by droplet route; these include, but are not limited to: Respiratory viruses (e.g., influenza, parainfluenza virus, adenovirus, respiratory syncytial virus, human metapneumovirus) Bordetella pertusis For first 24 hours of therapy: Neisseria meningitides, group A streptococcus

Standard precautions apply to all patients regardless of their diagnosis

blood all

other body fluids, secretions and excretions (except sweat), regardless of whether they contain visible blood non-intact skin mucous membranes (mouth and eyes)

Personal Protective Equipment

Gloves, Health

aprons, gowns, eye protection, and face masks

care workers should wear a face mask, eye protection and a gown if there is the potential for blood or other bodily fluids to splash.

Personal protective equipment

Masks should be worn

if

an airborne infection is suspected or confirmed

to protect an immune compromised patient.

Gloves
Gloves must be worn for:

all invasive procedures contact with sterile sites

contact with non-intact skin or mucous membranes

all activities assessed as having a risk of exposure to blood, bodily fluids, secretions and excretions, and handling sharps or contaminated instruments.

Hands should be washed before and after gloving

Gloves
Purpose patient care, environmental services, other Glove material vinyl, latex, nitrile, other

Sterile or nonsterile
One or two pair Single use or reusable PPE Use in Healthcare Settings

Gloves

Purpose patient care, environmental services, other Glove material vinyl, latex, nitrile, other Sterile or nonsterile One or two pair Single use or reusable

Dos and Donts of Glove Use

Work from clean to dirty Limit opportunities for touch contamination protect yourself, others, and the environment
Dont touch your face or adjust PPE with contaminated gloves Dont touch environmental surfaces except as necessary during patient care
PPE Use in Healthcare Settings

Safe Use and Disposal of Sharps

Keep handling to a minimum Do not recap needles; bend or break after use Discard each needle into a sharps container at the point of use Do not overload a bin if it is full

Do not leave a sharp bin in the reach of children

Dos and Donts of Glove Use (contd)

Change gloves
During

use if torn and when heavily soiled (even during use on the same patient) use on each patient

After

Discard in appropriate receptacle

Never
PPE Use in Healthcare Settings gloves

wash or reuse disposable

Required Performance
Nursing students need to: aapply universal precautions be immunized against Hepatitis B use personal protection methods know what to do if exposed eencourage others to use universal precautions

Prevention through hand washing

how to clean hands

rationale for choice of clean hand practice technique for hand hygiene protecting hands from decontaminates promoting adherence to hand hygiene guidelines

Face Protection
Masks protect nose and mouth Should fully cover nose and mouth and prevent fluid penetration

Goggles protect eyes

Should fit snuggly over and around eyes Personal glasses not a substitute for goggles Antifog feature improves clarity
PPE Use in Healthcare Settings

Face Protection
Face

shields protect face, nose, mouth, and eyes

Should

cover forehead, extend below chin and wrap around side of face
PPE Use in Healthcare Settings

Respiratory Protection
Purpose protect from inhalation of infectious aerosols (e.g., Mycobacterium tuberculosis) PPE types for respiratory protection
Particulate respirators Half- or full-face elastomeric respirators Powered air purifying respirators (PAPR)

PPE Use in Healthcare Settings

Respiratory Protection

infectious aerosols (e.g., Mycobacterium tuberculosis) PPE types for respiratory protection

Particulate respirators
Half- or full-face elastomeric respirators Powered air purifying respirators (PAPR)

Sequence* for Donning PPE

Gown first

Mask or respirator
Goggles or face shield

Gloves
*Combination of PPE will affect sequence be practical
PPE Use in Healthcare Settings

How to Don a Gown

Select appropriate type and size

Opening is in the back

Secure at neck and waist

If gown is too small, use two gowns
Gown #1 ties in front Gown #2 ties in back
PPE Use in Healthcare Settings

How to Don a Mask

Place over nose, mouth and chin
Fit flexible nose piece over nose bridge

Secure on head with ties or elastic

Adjust to fit
PPE Use in Healthcare Settings

Safe Injection Practices

Outbreaks of hepatitis B and hepatitis C infections in US ambulatory care facilities have prompted the need to re-emphasize safe injection practices. All health care personnel who give injections should strictly adhere to the CDC recommendations - Safe Injection Practices which include: Use of a new needle and syringe every time a medication vial or IV bag is accessed Use of a new needle and syringe with each injection of a client Using medication vials for one client only, whenever possible

Contact precautions may be needed for germs that are spread by touching.

Everyone who enters the room who may touch the patient or objects in the room should wear a gown and gloves. These precautions help keep staff and visitors from spreading the germs after touching a patient or an object the patient has touched. Some of the germs that contact precautions protect us from are C.difficileand norovirus, and respiratory syncytial virus (RSV). These germs can cause serious infection in the intestines.

Summary
Know

the main guidelines in each of the clinical environments you are assigned. Accept responsibility for minimizing opportunities for infection transmission. Let staff know if supplies are inadequate or depleted.

Summary

Educate

patients and families/visitors about clean hands and infection transmission. Ensure patients on precautions have same standard of care as others:
frequency

of entering the room vital signs

monitoring

Hepatitis B Vaccination a Must for all Health care Professionals

Never forget to Wash your Hands

Yet there is no Substitute for HAND WASHING in Prevention of Infections

 Programme

Created and Designed by Dr.T.V.Rao MD for Medical and Health Care workers in Developing World
Email
doctortvrao@gmail.com