Hospital Infection Control and Prevention Programme Dr Wasana Kudagammana 1 Why and How?

A Tribute to Ignaz Semmelweiss ( ) Obstetrician, practised in Vienna Studied puerperal (childbed) fever Established that high maternal mortality was due to failure of doctors to wash hands after post- mortems Reduced maternal mortality by 90% Ignored and ridiculed by colleagues 2

The very first requirement in a hospital is that it should do the sick no harm

What is Hospital Acquired Infections Any infection that is not present or incubating at the time the patient is admitted to the hospital 4

What we do?

Why Everyone Concerned with Hospital Infections? 6

Additional morbidity Prolonged hospitalization Long-term physical, developmental and neurological sequelae Increased cost of hospitalization Death 7 Consequences of Hospital Acquired Infections

MICROORGANISMS HEALTH CARE WORKER BACTERIA VIRUSES PRIONS FUNGI TRANSMISSION CONTACT INOCULATION INHALATION INGESTION Health Care Workers Patient Environment

What is IC & Prevention? Infection control addresses – factors related to the spread of infections within the health-care setting (whether patient-to-patient, from patients to staff and from staff to patients, or among- staff) including prevention of acquiring new infections (via hand hygiene/hand washing, cleaning/disinfection/sterilization, vaccination, surveillance) – monitoring/investigation of demonstrated or suspected spread of infection within a particular health-care setting (surveillance and outbreak investigation) – management (interruption of outbreaks) – immunization of HCW/Pt 9

Contact!!! 10 Most important route of transmission of HAI is the direct contact from the hands of health care worker

Break the Chain of Infections 11

Sources of HAIs Hands of staff – direct contact Environment indirect contact Contaminated instruments / equipment IV lines – central & peripheral Assisted ventilation equipment Suction & drainage bottles Urinary catheters Wounds & wound dressings Procedures

Guidelines and recommendations Hand washing Hospital environmental control & instrument care Intravascular Device- Related Infections and its control Isolation Precautions Immunization of HCW 13

Handwashing is the single most important procedure for preventing the transmission of nosocomial infections.

Simple evidence… Hand hygiene is the single most effective measure to reduce HCAIs

1st principle of infection prevention At least 35-50% of all nosocomial infections associates with patient care practices: Hand hygiene and standard precautions Use and care of urinary catheters Use and care of vascular access lines Therapy and support of pulmonary functions Experience with surgical procedures

Handwashing … an action of the past (except when hands are visibly soiled) Alcohol-based hand rub is standard of care 1. Recognized 2. Explained 3. Act

How to clean your hands…

BEFORE AFTER

Sax H, Allegranzi B, Uçkay I, Larson E, Boyce J, Pittet D. J Hosp Infect 2007;67:9-21 “My 5 Moments for Hand Hygiene”

Rub hands… it saves money

Clinical Guidelines/ Bundle care 1.Patient/Skin preparation for procedures – routine/invasive/minor/major 2.Prevention of infections related to IV catheters 3.Urinary catheterization 4.ET/Tracheal tube care 5.Wound care 6.Management of surgical drains etc 7.PD Catheter care …………..etc 25

Eggimann and Pittet Sepsis Monitor 2000 Education-based, multimodal prevention strategy for devise related infections

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Good House Keeping a Boon to Infection Control 28

Remember: everything you touch has been touched by someone else

Scientific Sterilization & Disinfection Practices Saves Lives 30

Surveillance The key to success - ongoing monitoring /surveillance for nosocomial infections Various techniques for surveillance have been described and evaluated including total house surveillance, targeted surveillance, Kardex, or laboratory-base 31

Infection Control Programme and Documentation Goals of the infection control program need to be incorporated into the mission statement of the facility A mission statement should tell who you are, what you do, and should communicate a clear view of purpose and set a strategy for accomplishing the goal! 32

Health Care Workers are at Risk – Need for Vaccination Health care workers may be exposed to certain infections in the course of their work Vaccines are available to provide some protection to workers in a healthcare setting Depending on regulation, recommendation, the specific work function, or personal preference, healthcare workers or first responders may receive vaccinations for hepatitis B, measles, mumps and rubella; Tetanus, diphtheria, pertussis; N. meningitides; and varicella. The problem of resources for proving Vaccines in Developing countries continues to be real problem, need additional economic resources Dr.T.V.Rao MD33

Alcohol-based handrub at point of care A ccess to safe, continuous water supply, soap and towels 2. Training and Education 3. Observation and feedback 4. Reminders in the hospital 5. Hospital safety climate The 5 core components of the WHO Multimodal Hand Hygiene Improvement Strategy 1. System change

System change Education Monitoring performance + feedback Reminders Safety culture A multimodal strategy

SAVE LIVES Multi modal Strategy

ry Making healthcare safer

38 Save Lives ! Clean Your Hands! Thank you!!!