Basic Princinciples of Infection Control
Transcript of Basic Princinciples of Infection Control
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BASIC PRINCIPLES AND
IDEAS OF INFECTION
CONTROL
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Objectives
Present some of the principles of infection
control
Discuss if you agree with these ideas and
principles
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Examples of HAI: a patient
develops
a urinary tract infection after having a urinarycatheter
measles from the patient in the next bed,
diarrhea that was not present on admission a surgical site infection after an operation
hepatitis C after receiving an injection with aused syringe
HIV from receiving a blood transfusion thatwas not tested
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Infection Control: first do no
harm
The health care we provide can diagnose
diseases, treat patients, relieve suffering and
prevent the spread of disease
Health care can also kill patients, spreaddisease, create epidemics and increase
suffering.
Health care workers can kill more persons intheir career than soldiers unless they practice
good infection control.
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HAI can appear quickly or months
later
Diarrhea from norovirus or staph aureus may
appear in hours
Surgical site infections in patients with
implants may not appear for 1 year
Patient in the same room as a patient with
MRSA may get colonized with the germs but
not develop an infection for 18 months Patients exposed to hepatitis may not develop
disease for 6 months
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We may not be aware of HAI
Physicians and nurses may not be aware of
health care infections that develop after the
patient goes home.
If a patient develops an infection they may not
come back.
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First do no harm
Every facility that provides health care must
have an infection control program to monitor
and prevent infections and injuries to patients
that may result from care.
Every facility must supervise and monitor the
PROCESSES of care to decrease the risk ofharm.
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Some procedures have more risk
of health care associated infections
Risk increases when:
Invasive procedures that break the skin or enter
normally sterile parts of the body
With implants and transplants or anything thatenters and stays in the body (including catheters,
sutures, drains, central lines, Infusions)
The longer the invasive procedure
If a surgical procedure is in a non-sterile part of
the body (respiratory tract, GI or reproductive
tract.
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HAI come from the patients germs
or those transferred to the patient
Present on the patients skin which can not
enter the body through an incision or puncture
(endogenous)
Present on the hands of care givers
Present on objects that touch the patient
Present on food, water or air
Germs may be viruses, bacteria, prions, orother pathogens.
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A core principle:
Separate clean from dirty
Dirty refers to any devices that has touched a
patient or been used
Clean refers to new, never used items or items
that have be cleaned and sterilized or
disinfected
They should NEVER be in the same physical
space. They should not cross paths
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Health care associated infections
(HAI)
Are common:
Can happen every time a patient is touched
In some settings 25% of patients get infections
Can kill patients
Transfusion reactions, contaminated IV fluids
May not be detected without dedicated
surveillance system
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Which option do you think is
true?
Are spread betweenpatients on the
hands of caregivers
Are carried betweenpatients by flies and
insects
Most health care infections Most health care infections
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Infection Control Practitioners
believe
Are spread betweenpatients on the
hands of caregivers
Most health care infections
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Which do you think is true?
One should workindependently toindividualize care andmodify procedures asthey see fit for eachpatient. It is best to
change howprocedures are doneto fit each patient.
One should practice
standardizedprocedure andfollow approvedindications; the
more that the carefollows evidencebased guidelines thebetter the outcome.
The best care proceduresshould be individualized toeach patient
The best care is standardizedprocedures
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Infection Control Practitioners
believe
One should practice
standardizedprocedure andfollow approvedindications; the
more that the carefollows evidencebased guidelines thebetter the outcome.
The best care is standardizedprocedures
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Which do you think is true?
Is a lifetime student
who is never donelearning.
Has completed their
knowledge and hasperfected their
knowledge base,
and mastered all
necessary concepts
A trained health profession A trained health professional
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Infection Control Practitioners
believe
Is a lifetime student
who is never donelearning.
A trained health profession
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Which do you think is true?
Infections and
patient injuries are
impossible to
prevent
Infections and
patient injuries are
preventable
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Infection Control Practitioners
believe
Infections and
patient injuries are
preventable
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In my practice
I see health care
associated
infections
I never see
healthcare
associated
infections
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Infection Control Practitioners
believe
I see health care
associated
infections
And if I dont seenthem, my
surveillance system
is to blame!
All health care
systems can be
improved
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ICP judge the quality of health care
by
The disease
outcomes including
death rate, rate of
infection, rates ofcomplications, rate of
being readmitted to
the hospital.
I believe goodhospitals monitor the
processes of care as
well.
The happiness of the
patient
The fame of the
provider The wealth of the
physician
The reputation of the
hospital
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ICP judge the quality of health care
by
The diseaseoutcomes includingdeath rate, rate ofinfection, rates of
complications, rate ofbeing readmitted tothe hospital.
Good hospitalsmonitor the processes
of care becausereducing the variationin processes controlsmuch of the variationin outcome.
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Surgeries and procedures are
Often unnecessary
and expose patientto disease, injuries
and unnecessary
costs
Always beneficialbecause other wise the
physician or nursewouldnt do them
There is an importantplacebo effect that can
always help the patientfeel better with the actof IV and other healthcare procedures.
UNNECESSARY NECESSARY
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Surgeries and procedures are
Often unnecessary
and expose patientto disease, injuries
and unnecessary
costs
UNNECESSARY
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ANTIBIOTICS ARE
The overuse ofantibiotics is a global
problem that createsmultiple drug resistantinfections.
Drug resistance isdangerous to thepatient and to thecommunity
OFTEN UNNECESSARY
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Alcohol hand rub
Is always less
effective than hand
washing with soap
and water
Is very effective at
preventing health
care associated
infections
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Alcohol hand rub
Is very effective at
preventing health
care associated
infections
P d th t k d i th
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Procedures that worked in the
past
They have been
proven by decades ofexperience and
tradition and are the
best way
The ways of the past
medical leaders will
remain effective
New infections, new
devices, changingpatient issues, andnew procedures
mean that what wassafe in the
community may notbe safe.
Change is
necessary
Should always be continuedMay not work well in the
future
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Steps in the process of care
Need to be
monitored and
supervised
regardless of whodoes them
For example handhygiene should be
monitored
Need to be
monitored only for
non-professional
staff
Individualprofessionals can be
trusted to do the
right thing.
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Steps in the process of care
Need to be
monitored and
supervised
regardless of whodoes them
For example handhygiene should be
monitored
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Wet and dry
Nothing should everbe stored wet in
disinfectants. Wet hands are
dangerous even afterbeing washedbecause they canpick up more germs
All disinfectants canbe contaminated bygerms
Store thermometersand frequently used
equipment indisinfectants toprotect patients
No germs can grow indisinfectants
Hands that are wetafter hand washing donot need to be dried
Wet surfaces have greater risk Wet means freshly cleaned
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Wet and dry
Nothing should everbe stored wet in
disinfectants. Wet hands are
dangerous even afterbeing washedbecause they canpick up more germs
All disinfectants canbe contaminated bygerms
Wet surfaces have greater risk
Wh IV i th t d
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When IVs, urinary catheters and
other devices are inserted properly
They can be left in
safely for the
maximum
recommended time
They should be
removed as soon as
possible.
Wh IV i th t d
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When IVs, urinary catheters and
other devices are inserted properly
They should be
removed as soon as
possible.
Wh bl it i b tt
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When problems occur, it is better
to
Encourage staff to
report problems,
discuss them openly
with all staffinvolved, and
monitor if things get
better or worse after
trying thesuggestions.
Not discuss
problems openly, as
they are usually due
to personal errorsand it is best to work
with the individual to
get them to change
their behavior.
Infection Control Practitioners believe
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Infection Control Practitioners believethat when problems occur, it is better
to
Encourage staff to
report problems,
discuss them openly
with all staffinvolved, and
monitor if things get
better or worse after
trying thesuggestions.
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Cleaning
Is less important if a
device is sterilized,
as germs and dirt on
the item will be killedduring sterilization
Is the step that
removes the most
germs from patient
care items. If adevice is not
cleaned, it can not
be sterilized.
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Cleaning
Is the step that
removes the most
germs from patient
care items. If adevice is not
cleaned, it can not
be sterilized.
Problems of the quality of care are
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Problems of the quality of care are
usually due to
The few individuals
who are lazy,
irresponsible and
careless
Systems of care that
have weakness due
to facilities,
equipment, taskdesign,
communication,
supplies, and
training.
Problems of the quality of care are
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Problems of the quality of care are
usually due to
Systems of care that
have weakness due
to facilities,
equipment, taskdesign,
communication,
supplies, and
training.
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Summary
IC Programs are necessary to prevent harm
from health care that is common and severe
Process monitoring is essential, standardized
care is desirable. Monitoring of outcomes isdesirable but resource intensive.
Separation of clean and dirty is key
Working in infection control involves frankdiscussion of issues, openness to change as
new problems and new information are
learned.