HAIs std precaution , safe injection.

1. Hospital acquired infections &
Standard infection control
precautions and safe injections

2.  major challenge to patient safety and contribute significantly
to morbidity and mortality,
 excess costs for hospital stay
Routes of transmission
Direct transmission from another host (healthy or ill) or
from an environmental reservoir or surface by direct contact or
direct large-droplet spread of infectious secretions is the
simplest route of agent spread.

3. Gram-positive bacteria, including Staphylococcus aureus and
Enterococcus spp., are able to survive for months on dry
surfaces.
Gram-negative bacteria, such as Klebsiella spp., Escherichia
coli, and Acinetobacter spp. can also survive for a relatively
long time on inanimate surfaces,
while common fungi such as Candida spp. have similar
properties.

4. The highest prevalence of HAI occurred in
 ICUs and acute care surgical and orthopedic settings.
 Old age, multiple morbidities or disease severity, and
 decreased immunity increase patient susceptibility.
 Poor infection control measures are an overall risk factor as are
certain invasive procedures including central venous or urinary
catheter placements.
 Antimicrobial misuse is associated with drug-resistant HAI .

5. Laboratory
diagnosis of
HAIs
A - Phenotypic methods
1-Biotyping
2-Antimicrobial susceptibility
testing
3-Serotyping
4-Bacteriophage and bacteriocin
typing
B-Genotypic methods
1- Plasmid Analysis
2- Pulsed-field gel electrophoresis
3-Southern Blot Analysis-Ribotyping
4-Northern blotting
5-Heteroduplex Migration Analysis
6-Single Strand Conformation Polymorphism Analysis
7-Typing Methods Using PCR
8 -DNA arrays
9 -Pyrosequencing
10 –Spectroscopy
11-Proteomics and metabolomics
12- Nucleotide sequence- based analysis

6. Standard infection control precautions
• Hand washing
• Personal protective equipment
• Safe handling of sharp instruments
• Safe disposal of waste
• Decontamination of equipment
• Environmental Decontamination &Cleaning and Treatment
of blood & body fluids spills

7. •Non- pharmacological hospital infection control strategies

10. Safe disposal of waste
• Segregation of waste
Discarded into appropriate color coded bag
• Handling & storage waste policy
After ¾ full closed & sealed and labeled . If there is leak use 2nd bag
over 1st bag
• Linen , uniform ,excreta
Used linen in white /clear bag .infected in red bag , heat labile in orange
stripe
Used and infected use thermal disinfection , heat labile wash at 40c add
specific rinse
Uniforms wash at hot water 50 c and excreta discareded safely

11. Type of waste
Color of bag
Household waste ,treated clinical waste
(e.g .paper ,food ,flower ,etc)
Black
Clinical waste (e.g. material contaminated
with blood or body fluid ,human or animal tissue )
Yellow
Needle syringes ,broken glass and any
other contaminated sharp item
Yellow sharps container
Waste for autoclaving (e.g. pathology
specimens)
Blue or transparent with blue inscription
Non-infectious human waste (e.g. sanitary
towels , incontinence pad )
Yellow black stripes

12. Safe handling of sharp instrument
• Don’t diassemble needles from syringe / other devices and discard as single unit
• Don’t re-sheathe needles
• Don’t carry used sharp by hand
• Discard sharps immediately after use into a sharp containers
• Place sharp containers at point of use
• Close sharp containers when ¾ full
Handling sharps in operating departments
Blunt suture needles – needle holder with needle tip guards ,blade removal devices –
double gloving –vacuum blood collection tubes

13. Management of blood exposure incidents
1- needle ,cuts ,scratches encourage bleeding by squeezing –wash with
soap % water , cover with water proof dressing
2- splashes to mouth or eyes , rinse thoroughly with plenty of running
water – report to occupational health department immediately
3- inform manager immediately ,complete accident form
4- blood sample sent to lab to screen for HBV ,HCV , HIV
5-HBV vaccinations for HCWs – antiviral treatment for HCV HCWs
6- HCWs perform exposure prone procedure (EPPs) should be free from
HBV ,HCV ,HIV viruses unless they vaccinated or treated and they
can't carry EPPs unless become free

14. Decontamination of equipment
Transmission of blood borne viruses through equipment used in invasive procedure
method used should be sufficient to prevent pathogen transmission between patients
Department such as intensive care and theatres which use suction , choose a
disposable suction system to avoid need to decontaminate suction jars
1- Critical devices present the highest risk as they enter a normally ‘sterile’ area of
the body, such as the bloodstream. Sterilization of these devices is recommended.
Typical sterilization processes use steam, ethylene oxide, liquid per acetic acid and
hydrogen peroxide gas
2- Semi-critical devices pose a lower risk as they may only contact mucous
membranes or non-intact (broken) skin.

15. High-level disinfectants, such as those based on heat (hot water for some devices),
glutaraldehyde, ortho-phthaldehyde , hydrogen peroxide and peracetic acid, could
provide rapid turn around times for these devices
3- Non-critical devices present the lowest risk to patients, as they may only contact
intact skin. Intermediate-level disinfectants provide efficacy against a broader group
of viruses (non-enveloped) and some mycobacteria. Ex include alcohol-, aldehyde-,
phenolic- and quaternary ammonium- compound-based disinfectants
Environmental Decontamination & Cleaning and Treatment of blood & body
fluids spills
Treatment of blood & body fluids spills by high concentration chlorine releasing
compounds esp. chlorine releasing granules better than hypochlorite solutions
Sometimes in large ward spills soaked up with disposable papers towels and
discarded in yellow waste bag then further cleaning with detergent and water

16. The potential for contaminated environmental surfaces to contribute to transmission
of healthcare-associated pathogens depends on a number of factors, including
• the ability of pathogens to remain viable on a dry environmental surfaces,
• the frequency with which they contaminate surfaces touched by patients and
healthcare workers
• whether or not levels of contamination are sufficiently high to result in
transmission to patients .
Disinfection methods can be classified as being physical or chemical in
antimicrobial activity . Physical methods include radiation and heat, while chemical
methods are based on the use of biocides such as alcohols, aldehydes, halogens and
quaternary ammonium compounds

17. Preventing Urinary tract infection
(1) Using catheters only when medically necessary
(2) assessing patients daily for catheterization and documenting a continued need
(3) using reminder systems for health care workers aimed at removing catheters
(4) using external catheters in men when feasible
(5) considering intermittent catheterization instead of indwelling catheter insertion
(6) promptly removing unnecessary urinary catheters.
(7) using aseptic technique during catheter insertion
(8) allowing only trained health care professionals to insert urinary catheters
(9) securing catheters to prevent movement and urethral traction
(10) keeping the drainage bag below the level of the bladder

18. (11) changing the indwelling catheter or urinary drainage bag only when necessary
(12) Other measures include avoiding irrigation unless the catheter is obstructed
(13) administering anti infective therapy only when an infection is suspected .
Preventing Central venous catheter infection
• precautions for CVC insertion (i.e. use of long-sleeved gown,-sterile gloves-
mask, cap and large sterile sheet drape , sterile gloves , chlorhexidine-containing
antiseptics - dressings should be considered for use over CVC insertion sites in
paediatric patients )
• Placement of CVCs in the femoral vein
• Use of vancomycin-containing catheter lock solutions
• Safe Disposal Of Sharp Instrument and Waste

19. Preventing respiratory tract infections
• Selective decontamination of the digestive tract (SDD), oropharyngeal
decontamination and combinations of these with or without the use of systemic
antibiotics
• Decolonization of the oropharynx using topical antimicrobial agents like
chlorhexidine (CHX)
• Supine patient positioning facilitates aspiration; semi recumbent positioning
decreases it . Kinetic beds or continuous lateral rotational therapy is a technique
using a continuous movement of the bed may decrease the risk of VAP
• Noninvasive positive pressure ventilation (NIV) using a face mask is an
alternative to intubation
• Vaccination of high-risk residents with pneumococcal vaccine

20. Preventing Surgical site infection ( Major headings )

21. Preventing Gastro intestinal infection
• Replacing tap water with sterile water for drinking, bathing and
procedures can significantly reduce rates of many HAIs including
crytosporidium, legionella, aeromonas and stenotrophomonas
• UV-light water treatment or Copper silver-based ionisation systems
can greatly reduce levels of legionella in hospital water systems
• Routine surveillance of hospital water supplies for legionella
• All water leaks and water damage should be repaired and remediated
within 24 h to prevent growth of pathogenic bacteria and moulds.
• Daily cleaning of patient shower areas with a detergent and phenolic
compound has been shown to significantly decrease airborne levels of
moulds including aspergillus

22. Preventing Burn infection
• Strict aseptic technique should be used when handling the open wound and
dressing materials and frequency of dressing
• Patients colonized with multiple drug resistant organisms or with larger burn
injuries (>25–30% Total Body Surface Area (TBSA) are also immuno
compromised, it is recommended that patients isolated in private rooms or
other enclosed bed spaces
• Pediatric burn patients have policies restricting the presence of non-washable
toys, such as stuffed animals and cloth objects.
• Routine cleaning, disposal of waste and gathering of soiled linen is essential
to reduce the load of organisms
• Plants and flowers should not be allowed because they harbor gram-negative
organisms, such as Pseudomonas species, other enteric gram-negative
organisms and fungi.

23. Isolation
• The hematology/oncology/ HSCT ward followed, with a high rate of patients
isolated for health care associated infections/MDRO colonization, in this case,
primarily contact isolation for gastrointestinal infection including VGI and
Clostridium difficile infection.
• It is important in pediatric settings given the high admission rates for viral
respiratory (VRI) and gastrointestinal (VGI) infections.
• All rooms housing TB patients should have at least 12 outdoor air changes per
hour (ACH) , have a negative pressure of at least 0.01 inch water, and the rooms
of patients with actual or suspected TB should be checked visually with tests such
as smoke tests

24. Injection safety
90 % injection are given for curative care
5 % for immunizations
5% for other indications
Pathogens associated with unnecessary & unsafe injections
HIV .HCV .VBV
Ebola , Marburg virus
Malaria , bacterial infection

25. Needle stick devices
Ampoule / vial - Syringe needle - Insulin needle - Intravenous kit -
Butterfly needle - Blood collection needle - Blood glucose lancet -
Spinal needle - Suture needle - Scalpel blade - Razor blade
Needle stick injuries ( single- multiple – contaminated – not reported )
NSIs correlations
Difficult work – fatigue – stress – high time pressure work – much
unplanned work – too much work – too much overtime – staff numbers
not enough

26. Spread of infection prevented by inf control program for
1- needles and syringes
2-single and multi dose vials and iv solutions
1- needles and syringes
• Avoid unnecessary injections
• Use sterile single use syringes and needles
• Never reuse or decontaminate syringes and needles
• Never put any used syringe / needle in vial
• Don’t administer medications from syringe to multiple patients even
needle or cannula is changed

27. • Use single use disposable syringe / needle
• Apply 60-70% alcohol based solution (ethyl alcohol / ethanol) on the
skin for 30 sec on single use swab or cotton ball and allow it to dry
• Don’t use methanol /methyl alcohol
• Don’t use cotton balls stored in multiuse container
•
2-single and multi dose vials and iv solutions
• Use single dose vial for iv medications
• Don’t use single use medications for more than 1 patient
• Don’t use infusion bags / bottles of iv fluids for multiple patients

28. • Limit use multi dose vials
• Use multi dose vials and keep in medication preparation area to prevent
contamination
• Don’t keep multi dose vial in in immediate patient ttt area
• Never leave needles / cover in vials entry diaphragms
• Once multi dose vial punctured it assigned as ( beyond use )
• Use new sterile needle , new syringe in multi dose vials
• Disinfect vials rubber septum by wiping / sterile 70% ethyl alcohol then dry
then use
• Avoid double dipping def using same syringe to inject more than 1 patient from
multi dose vial

29. •
Injection equipment and injection preparation area
• Avoid sterile injection equipment contamination
• Use aseptic non touch technique
• Use disposable fluid infusion sets ( iv bags , tubing , connectors ) for
one patient only
• Once syringe / needles /cannula used consider it as contaminated
• Injection preparation area / room must be clean area , not
contaminated by blood or body fluids
• Needle discarded into robust ,sharp container (waste)
• Contaminated items is brought to dirty area ( waste )

30. General infection control measures
 Proper hand washing
 Better nutrition
 Housing patients in separate rooms
 Sufficient numbers of nursing staff
 Coated urinary and CVCs
 Lower overall antibiotic use which will reduce risk of antibiotic-
resistant organisms and improve efficacy of antibiotics given to
patients who acquire nosocomial infections.
 Molecular technique can be very effective in tracing the spread of
nosocomial infection .

31. Thank you