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