Infection Control
Infection control
Lynn Johnson, hospital epidemiologist
Microorganisms are spread by:
direct contact - transfer fom person to person: most common and important
indirect contact - passive transfer via an intermediate object - health care providers, instruments, or other objects
droplets - large droplets coughed or sneezed, up to 2 m
airborne - chicken pox, tuberculosis, measles
common vehicle - ie contaminated vial
vector-borne -
possible consequencs of transmission:
disease
prolonged hospital stays
costs of therapies, precautions, outbreaks
changes in institutional flora
protecting patients from harm
liability
NEJM 2003, 348:651-6
in CDHA, 6/100 hospitalized patients pick up MRSA
MRSA is a big deal
SARS
we need to be instructed on how to wear respirators, how to take gear off
Bacterial counts range from 5000-5000,000 colongy-forming units per square cm. Hair, axillaie, and groin have the highest concentrations. Skin crevices on the hands hold 10-20% of flora, and fingernails are worst. s
routine practices
universal precautions
hand hygiene
the best, cheapest way of preventing infections
wash before and after work shift
before and after direct patient contact
after removal of gloves
before and after eating or personal hygiene
after contact with potentially contaminated environmental surfaces
routine practices
gloves are a reasonably good thing
masks, face shields, protective eyewear
- all procedures likely to generate aerosolized droplets
gowns
sharps
never re-cap
do not care for patients if you:
have an active GI illness
have chickenpox or shingles
have an acute febrile respiratory illness during influenza season or have not been vaccinated
have conjunctivitis
have exudative dermatitis or draining skin lesions
contact precautions
may be indicated for certain organisms when routine practices are not sufficient to control transmission
when:
-low infective dose
may be transmitted from patient's intact skin
droplet precautions
prevent contact with respiratory droplets
masks, eye protection, gloves
airborne precautions
administrative and engineering controls, personal particulate respirators
think of the setting
https://content.nejm.org/cgi/content/full/348/7/651
sanitation
Are hygiene and public health interventions likely to improve outcomes for Australian Aboriginal children living in remote communities? A systematic review of the literature. BMC Public Health. 2008 May 8;8:153
scenarios
wash hands first; nails, cuticles
when done, remove gloves first, then goggles, gown, and mask.
wash then the stuff (ie stethescope) using a diaper pad
IWK has WHO's 'yellow pages', outlining infectious bugs
Kids are grabby
rotavirus
RSV
scabies
lice
influenza
Resources and References
Gawande A. 2004. On Washing Hands. NEJM. 350(13):1283-1285.