PATIENT SAFETY AND INFECTION

CONTROL

Presenter:Shamsadeen A. Muhammad

Learning Objectives1. Recognize patient safety as an important

nursing responsibility in global health care systems.

2. Apply required knowledge in preventing and/or minimizing infection.

3. Perform appropriate behaviors required to prevent health care associated infections.

4. Demonstrate required competence to provide patients with safe care.

Introduction to Patient Safety:

DefinitionPatient safety is a discipline in the health

care sector that applies safety science methods toward the goal of achieving a trustworthy system of health care delivery. Patient safety is also an attribute of health care systems; it minimizes the incidence and impact of, and maximizes recovery from, adverse events (Emanuel et al., 2008) .

Introduction to Patient Safety: Background

Adverse medical events are widespread and preventable (Emanuel et al., 2008) .

Much unnecessary harm is caused by health-care errors and system failures.– Ex. 1: Hospital acquired infections from

poor hand-washing.– Ex. 2: Complications from administering

the wrong medication.

Introduction to Patient Safety:Goal

Prevent and/or minimize the adverse events and eliminate preventable harm in health care.

All health care professionals including nurses are responsible for ensuring patient safety

Introduction to Patient Safety:

This unit of patient safety will focus on Infection Control

Global Infection Problems

According to WHO (2005),o On average, 8.7% of hospital patients suffer

health care-associated infections (HAI).o In developed countries: 5-10% o In developing countries: – Risk of HAI: 2-20 times higher– HAI may affect more than 25% of patients

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

Health Care-Associated Infections (HAI)

According to WHO:o HAI is also called “nosocomial”.o HAI is defined as: – an infection acquired in hospital by a

patient who was admitted for a reason other than that infection.

– an infection occurring in a patient in a hospital or other health-care facility in whom the infection was not present or incubating at the time of admission.

Impacts of Health Care-Associated Infections (HAI)

HAI can: Increase patients’ suffering.Lead to permanent disability.Lead to death.Prolong hospital stay. Increase need for a higher level of care. Increase the costs to patients and

hospitals.

Preventing infections

Requires health care providers who have: –Knowledge of common infections and their vectors–An attitude of cooperation and commitment –Skills necessary to provide safe care

Required Knowledge

Knowledge of the extent of the problem;

Knowledge of the main causes, modes of transmission, and types of infections.

Required Attitudes

Being an effective team player.

Commitment to preventing HAIs

Required Skills

Apply universal precautions*Use personal protection methodsKnow what to do if exposedEncourage others to use universal

precautionsReport breaks in technique that increase

patient risksObserve patients for signs and symptoms

of infection

One more important thing!

Protect YourselfProtect Yourself Be sure you have been immunized

against Hepatitis B since it is very easy to transmit!

Main Sources of Infection

Person to person via hands of health-care providers, patients, and visitors

Personal clothing and equipment (e.g. Stethoscopes, flashlights etc.)

Environmental contaminationAirborne transmissionHospital staff who are carriers Rare common-source outbreaks

Main Routes for infections

Urinary tract infections (UTI)-Catheter-associated UTIs are the most

frequent, accounting for about 35% of all HAI.Surgical infections: about 20% of all HAIBloodstream infections associated with the use

of an intravascular device: about 15% of all HAIPneumonia associated with ventilators:

about15% of HAI

Four Ways to Prevent HAI

1. Maintain cleanliness of the hospital.2. Personal attention to handwashing

before and after every contact with a patient or object.

3. Use personal protective equipment whenever indicated.

4. Use and dispose of sharps safely.

Prevention through Handwashing

Handwashing: the single most important intervention before and after patient contact.

Required knowledge and skills:– How to clean hands– Rationale for choice of clean hand

practice– Techniques for hand hygiene– Protect hands from contaminants– Promote adherence to hand hygiene

guidelines

Five moments for hand hygiene

Before patient contact.Before an aseptic task.After body fluid exposure even if

wearing gloves!After patient contact.After contact with patient

surroundings.

Your 5 moments for HAND HYGIENE

How to Clean Hands

Remove all wrist and hand jewelry.Cover cuts and abrasions with

waterproof dressings.Keep fingernails short, clean, and

free from nail polish.

Effective Handwashing Technique

Wet hands under tepid running waterApply soap or antimicrobial preparation– solution must have contact with whole

surface area of hands– vigorous rubbing of hands for 10–15

seconds – especially tips of fingers, thumbs and

areas between fingersRinse completelyDry hands with good quality paper towel.

How to use waterless handrub

Apply a palmful of product in cupped hand Rub hands palm to palm Right palm over left hand with interlaced fingers Palm to palm with fingers interlaced Backs of fingers to opposing palms with fingers

intelocked Rub between thumb and forefinger Rotational rubbing, backwards and forwards with

clasped fingers of right hand in left palm and vice versa

Once dry your hands are safe.

Personal Protective Equipment 1

Gloves, aprons, gowns, eye protection, and face masks

Health 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 2

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

Safe Use and Disposal of Sharps

Keep handling to a minimum Do not recap needles; bend or break

after useDiscard each needle into a sharps

container at the point of useDo not overload a bin if it is fullDo not leave a sharp bin in the reach

of children

Act to Minimize Spread of Infection-1

Before contact with each and every patient:– clean hands before touching a

patient – clean hands before an aseptic

task

Act to Minimize Spread of Infection-2

After contact with each and every patient: – clean hands after any risk of

exposure to body fluids– clean hands after actual patient

contact– clean hands after contact with

patient surroundings

Summary-1

1. Know the main guidelines in each of the clinical environments you are assigned.

2. Accept responsibility for minimizing opportunities for infection transmission.

3. Let staff know if supplies are inadequate or depleted.

Summary-2

1. Educate patients and families/visitors about clean hands and infection transmission.

2. Ensure patients on precautions have same standard of care as others:– frequency of entering the room–monitoring vital signs

Thank you for listening

References o World Health Organization. (2010). WHO Patient Safety

Curriculum Guide for Medical Schools. o World Health Organization. (2010). Topic 1: What is patient

safety?o World Health Organization. (2010). Topic 9: Minimizing

infection through improved infection control.o Emanuel, L., Berwick, D., Conway, J., Combes, J., Hatlie, M.,

Leape, L., Reason, J., Schyve, P., Vincent, C., & Walton, M. (2008). What exactly is patient safety? Advances in Patient Safety, Vol. 1: Assessment. Retrieved from http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=aps2v1&part=advances-emanuel-berwick_110

o Burke, J. P. (2003). Infection control — A problem for patient safety. The New England Journal of Medicine, 348, p. 651-656.