Download MBBS Pediatric PPT 4 Infection Control Neonatal Transport Modified Lecture Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Pediatric PPT 4 Infection Control Neonatal Transport Modified Lecture Notes


INFECTION PREVENTION&

TRANSPORTATION IN

NEONATOLOGY

INFECTION CONTROL IN NICU-LEARNING

OBJECTIVES

Improved hand hygiene compliance

Barrier precautions/ Barrier nursing

Reduction of environmental contamination

Antibiotic restriction policies
HAND HYGIENE IN HEALTHCARE

SETTINGS: AN OVERVIEW

. Background
. Definitions
. Indications
. Selection of Agents
. Techniques

Guideline for Hand Hygiene in Health-care Settings. MMWR 2002;

vol. 51, no. RR-16.

SO WHY ALL THE FUSS ABOUT HAND

HYGIENE?

Most common mode of transmission

of pathogens is via hands!

............and the reason for
.Infections acquired in healthcare
.Spread of antimicrobial resistance
EVIDENCE OF RELATIONSHIP BETWEEN HAND

HYGIENE &

HEALTHCARE-ASSOCIATED INFECTIONS

. Substantial evidence:

hand hygiene reduces the incidence of infections

. More recent studies: rates lower when antiseptic

handwashing was performed

Guideline for Hand Hygiene in Health-care Settings. MMWR 2002;

vol. 51, no. RR-16.

DEFINITIONS

Hand hygiene

Performing handwashing, antiseptic handwash, alcohol-based

handrub, surgical hand hygiene/antisepsis

Handwashing

Washing hands with plain soap and water

Antiseptic handwash

Washing hands with water and soap or other detergents containing

an antiseptic agent

Guideline for Hand Hygiene in Health-care Settings. MMWR 2002;

vol. 51, no. RR-16.
DEFINITIONS

Alcohol-based handrub

Rubbing hands with an alcohol-containing preparation

Surgical hand hygiene/antisepsis

Handwashing or using an alcohol-based handrub before

operations by surgical personnel

Guideline for Hand Hygiene in Health-care Settings. MMWR 2002;

vol. 51, no. RR-16.

Procedural Handwashing
Procedural Handwashing

Why hand washing?

Simply put...hand hygiene saves lives!
Hand washing is one of the "most important
means of preventing the spread of infection

CDC Guidelines
FLORA ON HANDS

Coagulase-negative staphylococci

Staph aureus

Pseudomonas aeruginosa

Entercococci

Candida spp

COLONIZED OR INFECTED:

WHAT IS THE DIFFERENCE?

People who carry bacteria without evidence of

infection (fever, increased white blood cell count) are

colonized

If an infection develops, it is usually from bacteria that

colonize patients

Bacteria that colonize patients can be transmitted

from one patient to another by the hands of

healthcare workers

~ Bacteria can be transmitted even if the

patient is not infected ~
The Iceberg

Effect

Infected

Colonized

The Inanimate Environment Can

Facilitate Transmission

~ Contaminated surfaces increase cross-transmission ~

Abstract: The Risk of Hand and Glove Contamination after Contact with a

VRE (+) Patient Environment. Hayden M, ICAAC, 2001, Chicago, IL.
HAND WASHING...

Hand washing is the no.1 prevention against spread of

ifetio,isideadoutside

the hospital settig...Itis

the cornerstone of infection control practice and

education for anyone who works in health care

Summit Medical Center, Oakland, California

Hand washing can the first line of defense against many

ifetiousdiseases...theAMAurges otoly

professionals but public also to adopt hand washing as
an important personal priority.

American Medical Association House of Delegates Resolution

409

DURATION FOR DIFFERENT TYPES OF HANDWASHING

Two minutes

before entering the unit
before performing any procedure
after handling any infected baby or secretions

15 seconds

before and after touching every baby
after touching unsterile surfaces and fomites

Guideline for Hand Hygiene in Health-care Settings. MMWR 2002;

vol. 51, no. RR-16.
TYPE OF HAND HYGIENE

. When hands are visibly dirty, contaminated, or

soiled,

wash

with

non-antimicrobial

or

antimicrobial soap and water. Thereafter, use an

alcohol-based handrub

. If hands are not visibly soiled, use an alcohol-

based handrub for routinely decontaminating

hands.

Handwash followed by hand rub theoretically superior!

Guideline for Hand Hygiene in Health-care Settings. MMWR 2002;

vol. 51, no. RR-16.

SELECTION OF HAND HYGIENE AGENTS: FACTORS TO

CONSIDER

Efficacy of antiseptic agent

Acceptance of product by healthcare

personnel

Characteristics of product

Skin irritation and dryness

Accessibility of product

Dispenser systems

Guideline for Hand Hygiene in Health-care Settings. MMWR 2002;

vol. 51, no. RR-16.
EFFICACY OF HAND HYGIENE

PREPARATIONS IN KILLING

BACTERIA

Good

Better

Best

Plain Soap

Antimicrobial

Alcohol-based

soap

handrub

Plain soap is

just not enough

Ability of Hand Hygiene Agents to

Reduce Ba

Ti c

me te

Afte r

r ia

Di

si o

n n

fecti Ha

on

nds

%

log

0 60

180 minutes

99.9 3.0

99.0 2.0

Alcohol-based handrub

(70% Isopropanol)

90.0 1.0

Antimicrobial soap

(4% Chlorhexidine)

0.0 0.0

Plain soap

Baseline

Adapted from: Hosp Epidemiol Infect Control, 2nd Edition, 1999.
Effect of Alcohol-Based Handrubs on

Skin

Condition

Self-reported skin score Epidermal water content

Dry

Healthy

6

27

5

25

4

23

3

21

2

19

1

17

0

15

Healthy

Dry

Baseline

2 weeks

Baseline

2 weeks

Alcohol rub Soap and water

Alcohol rub

Soap and water

~ Alcohol-based handrub is less damaging to the skin ~

Boyce J, Infect Control Hosp Epidemiol 2000;21(7):438-441.

TIME SPENT CLEANSING HANDS:

ONE NURSE PER 8 HOUR SHIFT

. Hand washing with soap and water: 56 minutes

? Based on seven (60 second) handwashing episodes per hour

. Alcohol-based handrub: 18 minutes

? Based on seven (20 second) handrub episodes per hour

~ Alcohol-based handrubs reduce time needed

for hand disinfection ~

Voss A and Widmer AF, Infect Control Hosp Epidemiol 1997:18;205-208.
RECOMMENDED HAND HYGIENE

TECHNIQUE

Handrubs

Apply to palm of one hand, rub hands together

covering al surfaces until dry

Volume: based on manufacturer

Handwashing

Wet hands with water, apply soap, rub hands

together for at least 15 seconds

Rinse and dry with disposable towel

Guideline for Hand Hygiene in Health-care Settings. MMWR 2002;

vol. 51, no. RR-16.

REASONS FOR NONCOMPLIANCE

. Handwashing agents cause irritation and dryness

. Sinks are inconveniently located/lack of sinks

. Lack of soap and paper towels

. Too busy/insufficient time

. Understaffing/overcrowding

. Patient needs take priority

Adapted from Pittet D, Infect Control Hosp Epidemiol 2000;21:381-386.
GLOVING

Wear gloves when contact with blood or other

potentially infectious materials is possible

Remove gloves after caring for a patient

Do not wear the same pair of gloves for the care of

more than one patient

Do not wash gloves

Remember the glove is for the patient also !!!

Guideline for Hand Hygiene in Health-care Settings. MMWR 2002;

vol. 51, no. RR-16.

EDUCATION/MOTIVATION PROGRAMS

Monitor healthcare workers (HCWs) adherence with

recommended hand hygiene practices and give

feedback

Implement a multidisciplinary program to improve

adherence to recommended practices

Encourage patients and their families to remind HCWs

to practice hand hygiene

Guideline for Hand Hygiene in Health-care Settings. MMWR 2002;

vol. 51, no. RR-16.
ADMINISTRATIVE MEASURES TO

IMPROVE HAND HYGIENE

Make improved hand hygiene an institutional

priority

provide appropriate administrative support and

financial resources

Place alcohol-based handrubs at entrance to

patient room, or at bedside

Provide HCWs with pocket-sized containers

Guideline for Hand Hygiene in Health-care Settings. MMWR 2002;

vol. 51, no. RR-16.

PERFORMANCE INDICATORS

Monitor and record adherence to hand

Provide feedback to healthcare workers about their

performance

Monitor the volume of alcohol-based handrub used

per 1,000 patient days

Monitor adherence to policies on wearing artificial

nails

Guideline for Hand Hygiene in Health-care Settings. MMWR 2002;

vol. 51, no. RR-16.
SUMMARY

ALCOHOL-BASED HANDRUBS:

WHAT BENEFITS DO THEY PROVIDE?

Require less time

More effective for standard handwashing than

soap

More accessible than sinks

Reduce bacterial counts on hands

Improve skin condition

BARRIER NURSING
CHAIN OF INFECTION

The interaction between

all the six elements of

the chain determine

whether an infection wil

result

INFECTION CONTROL

Sources of microorganisms can include:

Patients
Health care workers
Visitors

These sources can include:

Persons with acute illness or infection
Those who are carriers, and
Those who are colonized with microorganisms (harbor the

organism without showing any apparent illness)

Inanimate objects such as furniture and medical

equipment can also be sources of microorganisms.
OBJECTIVE ? BARRIER NURSING

The main aim is to create a barrier to

the passage of infectious pathogenic
organisms between the contagious patient
and other patients and staff in the hospital

WHAT DOES IT CONTAIN?

Ensure that patient care items, bedside equipment, and

frequently touched surfaces receive daily cleaning

USE DEDICATED

Thermometer
B/P cuff
Stethoscope
Oxygen source & tubing
Suction tubings
Antibiotics & other medications
Resuscitation kit
Baby tray

They must be cleaned daily
BARRIER NURSING CONTD...

BN reduces but does not completely eliminate the

possibility of infection

BN is only effective if used correctly and at all times

where contact may occur

The use of Barrier Nursing does not replace basic

hygiene measures such as hand-washing, it is still very

essential to prevent transmission.

GOOD NICU PRACTICES

PREVENT ENTRY OF MICROBES INTO NICU

PREVENT PROLIFERATION OF MICROBES

PREVENT SPREAD OF MICROBES

PRACTICES ? PROTECTS NEWBORN FROM DEVELOPING

INFECTION
PREVENT ENTRY OF MICROBES



MAINTAINING A CLEAN ENVIRONMENT OUTSIDE NNN--

LABOUR ROOM

BUFFER ZONE



ENTRY RESTRICTIONS?

FAMILY MEMBERS

ENTRY OF INFECTED BABIES

PERSONNEL OF NURSERY

PERSONNEL OF ALLIED SERVICES

HAND WASHING ?SINGLE MOST IMPORTANT INTERVENTION

GOWNS / MASKS /SLIIPERS

AIR CHANGES

12 AIR CHANGES /HOURS

0.5 BACTERRIAL FILTER

-

PREVENT PROLIFERATION OF MICROBES IN

NNN

EQUIPMENT DISINFECTION

GOOD HOUSE KEEPING--

FLOORS

WALLS

FANS

REFRIGERATOR

SINKS

BUCKETS
PREVENTION OF SPREAD OF MICROBES

BETWEEN BABIES

PREVENT OVER CROWDING--4-6 FEET SPACE

STAFFING PATTERN--

1 :1

MULTI DRUG RESISTANT ORGANISM

1:2

SUSPECTED SEPSIS,SEPSIS WITH ORGANISMS

SUSCEPTIBLE TO WIDE RANGE OF DRUGS.

1:3

SEPTIC BABIES RECEIVED AB AND PRESENTLY NON ?

INFECTIOUS

1:4

STABLE BABIES

HAND WASHING

DISPOSABLE

LAMINAR FLOW

PROHIBITING OF STOCK SOLUTIONS

FOMITES- UNDERESTIMATED

FILES

STETHOSCOPES

EXAMINATION TRAY

PENS

COFFEE/TEA MUGS

TELEPHONES
PROTECT NEW BORNS FROM DEVELOPING INFECTIONS

BREAST FEEDS/MILK

INVOLVEMENT OF MOTHER

EARLY DISCHARGE POLICY

CORD CARE

SKIN CARE

HANDLING OF PARENTERAL FLUID/ DRUGS

HANDLING OF INVASIVES LINES AND TUBES

PERIPHERAL LINES

CENTRAL LINES

REMOVING LINES

MINIMIZE HANDLING.

ASEPETIC PRECAUTIONS DURING PROCEDURES

HAND WASHING BEFORE

INTRAVENOUS LINES

ET SUCTIONING

ET INSERTION , L P, DVET, CENTRAL LINE INSERTION----

SAME SANCTITY AS SURGICAL PROCEDURE
PRACTICES ENABLE BETTER ADMINISTRATION

ENVIRONMENT SURVEILLANCE

RECORD OF POSITIVE CULTURE.

MOTIVATING THE STAFF.

NEONATAL TRANSPORT

INDICATIONS

BEST transport method: in-utero transport

Monitoring during transportation

Complications
INDICATIONS

Need for higher care

Need for high frequency

Need for iNO

Need for ECMO

Need for hypothermia/whole body cooling/head cooling

Need for cardiac procedure

Lack of NICU bed/expertee/equipment

PREPARE FOR TRANSPORT

Check ID, compare with mothers folder.

IV fluids ( Neonatalyte)

History

Reason for transfer

Escorts?
MONITORING
COMPLICATIONS

HIGH RISK NEONATE:
COMPLICATIONS DURING TRANSPORT

Hypoxia

Hypoglycaemia

Hypothermia

Hyperbilirumenaemia

Hypovolaemia

Heavy sedation

Infection

HISTORY OF REGIONALIZED TRANSPORT

Medical transports date back as early as Ceasar

? First transport isolette (1893)

? Newborn inter-hospital transport--9's

? Chicago Dept. of Health System--9's

? Assisted ventilation on transport--9's France

? Modern transport--97's Usher, Canada
ROTCH-PUTNAM INCUBATOR(CIRCA 1893)
THE OBSTETRICAL BAG TRANSPORT

INCUBATOR (1922)
DE LEE & WELDE TRANSPORT

INCUBATORS 9'S)

NOVEL THERAPIES & EQUIPMENT: AVAILABLE DURING
TRANSPORT

ELBW (surfactant, thermoregulation)

? Inhaled Nitric Oxide

? ECMO

? Ventilators (HFOV)

? Brain Cooling

MRI Transport Incubator

? Capnography

? Wireless internet and more

? Telemedicine (consults, ECHO, U/S)

? Cong. Heart defects/transport to Cath lab

ECMO: ON TRANSPORT

ECLS started at referring hospital
? Time is of the essence
? Must weigh benefit vs. risks and costs
? Team to include surgeons, neonatologists,

perfusionists, RRT 's, ECMO nurses

? Need to be equipped, self-sufficient for 24h
? Cornish (Wilford Hall Air Force Base) first to use
portable ECMO on isolette (1987 & 1991) C-9 aircraft
? Now 16 year military experience (Wilson, Pediatrics,
2002)

HIGH FREQUENCY VENTILATION DURING TRANSPORT

. To treat severe RDS/ ARDS
? Minimizes barotrauma
? Uses low TV & high rates
? NICU units NOT portable
? Transport models being developed & tested

MCQS: INFECTION CONTROL

To perform hand hygiene activity, the minimal time

needed using alcohol based handrub is
10 Sec

b) 20 Sec

c) 30 sec

d) 40 sec

To perform hand hygiene activity, the minimal time

needed using soap and water is

10 Sec

b) 20 Sec

c) 30 sec

d) 40 sec

How many moments for hand hygiene exist according

to WHO

a)4

b) 5 c) 6 d) 7

What is the most frequent source responsible for health

care-associated infections?
a) The hospital's water syste ) The hospital air

c) Germs already present on or within the patient d)

The hospital environment

Which of the following require hand hygiene actions

(hand rub/hand washing)?

Before touching a patient Y / No

Immediately after body fluid exposure

Yes /

No
After exposure to the immediate surroundings of a

patient

Ye s / No

Immediately before a clean/aseptic procedure

Ye s / No

After touching a patient

Ye s / No

This post was last modified on 07 April 2022