Infection Control Plan MHA, NURSPH Rose Hogan Oct 2013 Infection Prevention and Control

What is Infection Prevention Control? Why do we care about it as hospital managers?

At the end of this session you should: Be able to explain what a hospital acquired infection is Understand the causes of disease Understand how disease is spread in the hospital Who is at risk of infection and why List the core components of an IPC programme Understand the benefit's of implementing infection control Understand your role in preventing HAI as a hospital administrator

Infection Hospital Acquired Infections Healthcare Acquired Infections HAI’s Nosocomial Infections Appear 48 hours or more after hospital admission or within 30 days after discharge Infections acquired while in hospital NOT the infections a patient presents with

Infection can be:

Example Mary goes to the A&E after a moto accident. Her left leg is broken. She has a history of TB infection and is receiving treatment. 4 days after surgery she has a high fever and her surgical wound is red and hot to touch. Do you suspect she has a HAI? Is her TB a HAI? Mary has a surgical site infection caused by a microorganism she acquired in the hospital. Her TB is not a hospital acquired infection – but it is a risk for causing a HAI in other patients.

What causes disease? Tiny living things!!! = ‘micro’ +‘organisms’- microorganisms

Microorganisms BACTERIA Single cell organism Mostly beneficial to the body Millions of types Can live in bodies, water, soil etc. Can only be seen with a microscope Have many ways of causing disease when in the body Usually only cause disease when they migrate from one part of the body to another

Example A bacteria called Staphlococcous Aureus lives all over our skin and does not cause infection there. We call these endogenous bacteria you cannot remove them. If this bacteria moves off the skin and into any part of the body it can cause infection.

Microorganisms VIRUS Tiny partially living organisms From the latin meaning TOXIC They are PARASITES - they depend on the body of the host to survive Millions of types Excellent at causing disease Not beneficial to the body Can only be seen with a microscope Have many ways of causing disease when in the body

Example HCV, Hepatitis C virus infects liver cells and causes inflammation of the liver when it infects the body. It is passed from person to person through infected blood.

Microorganisms FUNGI Are larger many cell organism Usually infect the skin and membranes Mostly cause disease in patients with a weak immune system i.e. Immunocomprimised patients

How disease is spread in the hospital Bacteria, Viruses and Fungi cannot walk, jump or fly! To get from one body to another they need a vehicle. How they are transported between people is called transmission. They travel in different ways from person to person. Understanding how the microorganism travels helps you design a way to stop them spreading. Microbes can live in a person or in the environment- we call this endogenous (coming from within) and exogenous (coming from outside) sources of infection.

Transmission Different Microorganisms travel in different ways!! Airborne Transmission Droplet Transmission Contact Transmission Indirect Contact Fecal- Oral Transmission

Droplets are large and fall to surrounding environment Airborne microbes are small and stay suspended in the air

Skin to Skin contact- Directly touching the microbe

Touching an object where the microbe is

Not washing hand after contact with feces

Cycle of transmission TB Other patients Cough Airborne + Droplet Inhalation/ breathing Another patient Drugs Isolation rooms Masks, cough in tissue Patient spacing, isolation Masks Patient spacing

Who is at risk of infection and why? Every person is potentially at risk of infection

Protection against infection

Those at high risk of infection Immunocompromised patients, e.g.: Neonates Infants Old Cancer patients Renal patients ICU patients Surgical patients Burns patients Any patient with an invasive device eg. IV cannulae, urinary catheter Those on certain drugs HIV/AIDS patients Malaria patients TB patients Those with a poor immunization history

To stop the spread of infection in hospital we implement a set of activities that collectively are called- Infection Prevention and control Standard Precautions: – work practices to achieve a minimum level of infection control – to be used by staff for ALL patients ALL the time – include- handwashing, sharps disposal, wearing of PPE, waste management, aseptic technique, instrument cleaning environmental cleaning

Components of Standard Precautions Hand HygieneWearing Gloves

Use of PPE

Linen Processing

Decontaminate Clean Sterilize Chemical High-pressure steam Dry heat Dry/Cool and Store High-Level Disinfect Boil Steam Chemical Instrument Processing

Environmental Cleaning/ House keeping

Safe work practice

Proper Healthcare waste managment

Proper healthcare Waste Manangement

Transmission based precautions: – the basic work practice activities for patients who are suspected or known to have an infection – depend on how the infection is transmitted Includes standard precautions + ??precautions. AirborneMask, isolation, ventilation DropletMask, patient spacing ContactGloves(standard) Fecal oralHandwashing (standard)

Core Components of an IPC program Handwashing Gloves Aprons Eye Goggles Masks Uniforms Theater shoes Sterile Services for instruments Waste managment Sharps Bins Hospital maintainence Staff Immunisation Laundry Microbiology laboratory HAI surveillance Environmental Cleaning Single use devices Staff Training IPC Committee

Benefits of implementing Infection Control Consider what advantages are there in implementing and infection control program in your hospital?

Patient Safety Reduce duration of hospital stay Increase wound healing time Do ‘no harm’ Duty of care

Frequent contact with blood and bodily fluids Occupational exposure to disease

Economic Benefits HAI’ are expensive Increased antibiotic use for patients Frequent use of lab resources Increased duration of stay in the hospital Frequent readmissions

Role of the Hospital Administrator in IPC IPC is everyone's business in the hospital! The HA has a responsibility as management staff to model good practice, e.g. – Handwashing – not wearing jewellery, etc. An essential role in supporting – the procurement of drugs, equipment – staff necessary for IPC and for facilitating the implementation of practices

Management systems and IPC Human resources, Staff patient ratios, Bed management, Patient pathways, Training, Information and it, Contract management, Procurement, Estates and facilities, Building design, Performance monitoring, Risk management, Resource allocation