Infection Prevention Overview

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Infection Prevention Overview

• MAQ Exchange

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Objectives

• Prevent infection of a client as a result of a
  procedure
• Protect both the healthcare worker and the client
  from acquiring a serious disease such as
  Hepatitis B or AIDS

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Objectives continued

• Identify the risk of acquiring HIV or HBV after a
  needlestick injury
• Describe how using protective barriers (standard
  precaution strategies) can make the workplace
  safer
• Select Personal Protective Equipment (PPE) a
  healthcare worker can use to reduce the risk of
  acquiring an infection
• Describe how to process instruments and other
  items using recommended IP practices
• Describe two methods to dispose of clinic waste

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How Risky is Working in Any Healthcare Setting?
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HIV Risk

• Risk of acquiring HIV after being stuck with a
  needle from an HIV client
• 4 1000

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HBV Risk

• Risk of acquiring HBV after being stuck with a
  needle from an HBV client
• 27 - 37 100

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• 800,000 needle sticks are reported by
  healthcare workers each year in the US

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HIV/AIDS Infection

• Worldwide
• 42 million people in the world are living with
  HIV/AIDS
• Your country or region
• Do you know?

Source UNAIDS/WHO December 2002.
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Consider Every Person (Client or Staff) Infectious
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Practices for Reducing theRisk of Disease
Transmission

• Between clients and staff
• Hand hygiene
• Using protective barriers
• Gloves
• Eyewear (goggles, face masks)
• Apron
• Safe work practices
• Not recapping/bending needles
• Safely passing sharps

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Practices for Reducing the Risk of Disease
Transmission

• From contaminated objects
• Processing instruments and other items
• Decontamination (staff)
• Cleaning (clients and staff)
• Sterilization (clients and staff)
• High-level disinfection (clients and staff)
• Proper waste disposal (staff and community)

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Handling Needles and Sharps
Processing Instruments
Hand Hygiene
Waste Disposal
Protective Barriers
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Hand Hygiene
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Hand Hygiene Practices

• Steps
• Use a plain or antiseptic soap.
• Vigorously rub lathered hands together for 10-15
  seconds.
• Rinse with clean running water from a tap or
  bucket.
• Dry hands with a clean towel or air dry them.

Source Larsen 1995.
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Alcohol/Glycerin Solution
Formula

• Add 2 ml glycerin to 100 ml 60-90 alcohol
  solution.
• Use 3 to 5 ml for each application and continue
  rubbing the solution over the hands for about 2-5
  minutes, using a total of 6 to 10 ml per scrub.

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Surgical Handscrub

• Antiseptic
• Running water
• Stick or brush for cleaning the fingernails
• Soft brush or sponge for cleaning the skin
• Towels

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Skin and Mucous Membrane Preparation

• Do not shave hair at the operative site.
• Ask the client about allergic reactions.
• Wash first with soap and water.
• Apply antiseptic in a circular motion.

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Cervical and Vaginal Preparations
Visualize the cervix, then

• Apply antiseptic solution liberally to the cervix
  (2 or 3 times) and then to vagina.

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Protective Barriers

• Wear goggles, face masks, aprons and closed shoes.

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Whats Wrong with This Picture?
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Wear Gloves
When handling soiled instruments, gloves and
other items
When performing a procedure
When disposing of contaminated waste items
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Protective Barriers

• Handling needles and sharps

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Protective Barriers
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Safe Handling of Needles and Sharps

• Disposal of needles and sharps

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Processing Instruments and Other Items
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Decontamination

• Practices
• Place instruments and reusable gloves in 0.5
  chlorine solution after use.
• Soak for 10 minutes and rinse immediately.
• Wipe surfaces (exam tables) with chlorine
  solution.

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Cleaning

• Practices
• Wash with detergent and water.
• Scrub instruments until visibly clean.
• Thoroughly rinse with clean water.

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Sterilization
Steam
Chemical
Dry-heat
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High-Level DisinfectionBoiling

• Practices
• Boil instruments for 20 minutes
• Always boil in pot with lid.
• Start timing when water begins to boil.
• Do not add anything to pot after timing begins.
• Air dry before use or storage.

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High-Level Disinfection Steaming

• Practices
• Steam for 20 minutes.
• Be sure there is enough water in bottom pan for
  entire steam cycle.
• Bring water to rolling boil.
• Start timing when steam begins to come from under
  lid.
• Do not add anything to pan after timing starts.
• Air dry and store in covered steamer pans.

Source McIntosh 1994.
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Steamer Used for High-Level Disinfection
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Chemical High-Level Disinfection

• Practices
• Cover all items completely with disinfectant.
• Soak for 20 minutes.
• Rinse with boiled water.
• Air dry before use and storage.

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Waste Disposal

• Practices
• Place contaminated items in leak-proof container
  or plastic bag.
• Dispose by incineration or burial.

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Infection prevention is everyones responsibility
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Conclusion

• IP cant be a stand-alone practice it needs to
  be integrated into all areas of the clinical
  reproductive health environment.
• IP principles can be adapted to any environment.
• IP is important its cheap you can do it!

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Infection Prevention Overview

• Optional Slides

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Accidental Exposure of HBV Infected Blood
As little as 10-8 ml (.00000001 ml) of
HBV-infected blood can transmit HBV to a
susceptible host.
Source Bond et al 1982.
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Skin Preparation Prior to Surgical Procedures

• Purpose
• To minimize the number of microorganisms on the
  skin or mucous membranes by
• Washing with soap and water
• Applying an antiseptic

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Effectiveness of Methods for Processing
Instruments
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Preparing a High-Level Disinfected Container

• Boil (if small), or
• Fill a clean container with 0.5 chlorine
  solution.
• Soak for 20 minutes.
• Pour out solution.
• Rinse thoroughly with boiled water.
• Air dry and use for storage of HLD items.

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Immunization for Adults

• Tetanus, diphtheria
• Chicken pox
• Measles, mumps, Rubella (German measles)

• Hepatitis A
• Hepatitis B
• Influenza
• Pneumococcus

Source CDC (Centers for Disease Control and
Prevention-Atlanta) June 1997.
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Making the Workplace Safer

• Support from hospital administrator
• Positive feedback from supervisor

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Making the Workplace Safer

• Role model actively supporting IP practices

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Use Needles and Syringes

• Use a new sterile disposable needle and syringe
  for each client.
• Or, use a sterile reusable needle and syringe for
  each client.
• Even if this is a second dose for the same
  client.

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Preventing Infection in the Healthcare Worker
Alternative Presentation
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Objectives

• By the end of this session, the participant will
  be able to
• Describe the risks to a healthcare worker of
  acquiring a serious infection in a healthcare
  setting
• Identify the risk of acquiring HIV or HBV after a
  needlestick injury
• Describe standard precaution strategies used to
  make the workplace safer
• Select Personal Protective Equipment (PPE) a
  healthcare worker can use to reduce the risk of
  acquiring a viral infection

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Some Biological Hazards

• Bacterial
• E. coli
• TB
• Streptococcus Group A
• Fungal
• Yeast
• Parasitic
• Malaria

• Viral
• HIV
• HBV
• HCV
• Rotavirus
• Ebola
• Papillomavirus

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How Risky is Working in Any Healthcare Setting?
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Risks of Dying from

• Lightning
• Plane crash
• Car accident
• Sky diving, bungee jumping

1 10,000,000 1 3,000,000 1 10,000 1 1000
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HIV Risk

• Risk of acquiring HIV after being stuck with a
  needle from an HIV client
• 4 1000

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HBV Risk

• Risk of acquiring HBV after being stuck with a
  needle from an HBV client
• 27 - 37 100

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• 800,000 needle sticks are reported by healthcare
  workers each year in the US

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HIV/AIDS Infection

• Worldwide
• 42 million people in the world are living with
  HIV/AIDS
• Local
• Do you know?

Source UNAIDS/WHO December 2002
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Standard Precaution Strategies

• To be useful, standard precaution strategies must
  address the fact that
• Most infectious agents are transmitted by contact
  with body substances (blood, feces or sputum)
  that contain them.
• Most infections are communicable for some period
  of time when symptoms are absent.

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Standard Precaution Strategies

• Hand hygiene

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Standard Precaution Strategies

• Personal Protective Equipment
• Gloves
• Mask/goggles/face shields
• Gown/apron
• Closed shoes

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Standard Precaution Strategies

• Handling needles and sharps

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Standard Precaution Strategies
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Standard Precaution Strategies

• Disposal of needles and sharps

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Standard Precaution Strategies
Immunization for adults

• Tetanus, diphtheria
• Chicken pox
• Measles, mumps, Rubella (German measles)

• Hepatitis A
• Hepatitis B
• Influenza
• Pneumococcus

Source CDC (Centers for Disease Control and
Prevention-Atlanta) June 1997.
64
Making the Workplace Safer

• Support from hospital administrator
• Positive feedback from supervisor

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Making the Workplace Safer

• Role model actively supporting IP practices

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Summary Infection prevention is everyones
responsibility