1. Patient Safety 1: Infection Control Yi-Hsiu Liu RN, MEd yhliu@wsu.edu Carol Allen Ph D carola@wsu.edu

2. Acknowledgments o World Health Organization – The World Health Organization is committed to promoting healthy outcomes for all of the world’s people. – This lecture is primarily based on the World Health Organization Patient Safety Curriculum Guide retrieved from http://www.who.int/patientsafety/educatio n/curriculum/en/index.html http://www.who.int/patientsafety/educatio n/curriculum/en/index.html

3. Learning Objectives 1.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.

4. Introduction to Patient Safety: Definition o Patient 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).

5. Introduction to Patient Safety: Background o Adverse medical events are widespread and preventable (Emanuel et al., 2008). o 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.

6. Introduction to Patient Safety: Goal o Prevent and/or minimize the adverse events and eliminate preventable harm in health care. o All health care professionals including nurses are responsible for ensuring patient safety

7. Introduction to Patient Safety: This unit of patient safety will focus on Infection Control

8. 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.

9. 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.

10. Impacts of Health Care-Associated Infections (HAI) HAI can: o Increase patients’ suffering. o Lead to permanent disability. o Lead to death. o Prolong hospital stay. o Increase need for a higher level of care. o Increase the costs to patients and hospitals.

11. 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

12. Required Knowledge o Knowledge of the extent of the problem; o Knowledge of the main causes, modes of transmission, and types of infections.

13. Required Attitudes Being an effective team player. Commitment to preventing HAIs

14. Required Skills o Apply universal precautions* o Use personal protection methods o Know what to do if exposed o Encourage others to use universal precautions o Report breaks in technique that increase patient risks o Observe patients for signs and symptoms of infection

15. One more important thing! Protect Yourself Be sure you have been immunized against Hepatitis B since it is very easy to transmit!

16. Main Sources of Infection o Person to person via hands of health-care providers, patients, and visitors o Personal clothing and equipment (e.g. Stethoscopes, flashlights etc.) o Environmental contamination o Airborne transmission o Hospital staff who are carriers o Rare common-source outbreaks

17. Campaigns to Decrease Infection Rates o WHO “Clean hands are safer hands” campaignClean hands are safer hands o Centers for Disease Control and Prevention (CDC) “prevent antimicrobial resistance” campaign in health-care settingsprevent antimicrobial resistance o Institute for Healthcare Improvement (IHI) “5 million lives” campaign5 million lives – Developing country focus Developing country focus

18. Main Routes for infections o Urinary tract infections (UTI) – Catheter-associated UTIs are the most frequent, accounting for about 35% of all HAI. o Surgical infections: about 20% of all HAI o Bloodstream infections associated with the use of an intravascular device: about 15% of all HAI o Pneumonia associated with ventilators: about15% of HAI

19. Burke J Infection control-a problem for patient safety New Eng Journal of Medicine (February 13, 2003) Types of Infections

20. 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.

21. Prevention in Hospitals and Clinics o Studies show infections are minimized when hospitals/clinics: – Are visibly clean; – Use increased levels of cleaning during outbreaks; – Use hypochlorite and detergents during outbreaks.

22. Prevention through Handwashing o Handwashing: the single most important intervention before and after patient contact. o 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

23. Five moments for hand hygiene o Before patient contact o Before an aseptic task o After body fluid exposure even if wearing gloves! o After patient contact o After contact with patient surroundings

24. Your 5 moments for HAND HYGIENE

25. How to Clean Hands o Remove all wrist and hand jewelry. o Cover cuts and abrasions with waterproof dressings. o Keep fingernails short, clean, and free from nail polish.

26. Effective Handwashing Technique o Wet hands under tepid running water o Apply 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 fingers o Rinse completely o Dry hands with good quality paper towel.

27. How to use waterless handrub o Apply a palmful of product in cupped hand o Rub hands palm to palm o Right palm over left hand with interlaced fingers o Palm to palm with fingers interlaced o Backs of fingers to opposing palms with fingers intelocked o Rub between thumb and forefinger o Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa o Once dry your hands are safe.

28. Resources for Correct Handwashing Procedures o Your Five Moments for Hand Hygiene o http://www.who.int/gpsc/tools/5momentsHandHygien e_A3.pdf http://www.who.int/gpsc/tools/5momentsHandHygien e_A3.pdf o How to handrub? How to handwash? o http://www.who.int/gpsc/tools/GPSC-HandRub- Wash.pdf http://www.who.int/gpsc/tools/GPSC-HandRub- Wash.pdf

29. Personal Protective Equipment o Gloves, aprons, gowns, eye protection, and face masks o 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.

30. Personal protective equipment 2 o Masks should be worn – if an airborne infection is suspected or confirmed – to protect an immune compromised patient.

31. Gloves Gloves must be worn for: o all invasive procedures o contact with sterile sites o contact with non-intact skin or mucous membranes o 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

32. Safe Use and Disposal of Sharps o Keep handling to a minimum o Do not recap needles; bend or break after use o Discard each needle into a sharps container at the point of use o Do not overload a bin if it is full o Do not leave a sharp bin in the reach of children

33. Required Performance Nursing students need to: o apply universal precautions o be immunized against Hepatitis B o use personal protection methods o know what to do if exposed o encourage others to use universal precautions

34. 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

35. 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

36. Encourage Others to Participate in Infection Control Students may routinely observe staff who: – apply inadequate technique in handwashing – fail to wash hands – routinely violate correct infection control procedures

37. Summary-1 o Know the main guidelines in each of the clinical environments you are assigned. o Accept responsibility for minimizing opportunities for infection transmission. o Let staff know if supplies are inadequate or depleted.

38. Summary-2 o Educate patients and families/visitors about clean hands and infection transmission. o Ensure patients on precautions have same standard of care as others: – frequency of entering the room – monitoring vital signs

39. 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 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.