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Dr.T.V.

Rao MD

Dr.T.V.Rao MD 1
A Tribute to
Ignaz Semmelweiss (1818-1865)

Ignaz Semmelweiss (1818-1865)



 Obstetrician, practised in
Vienna
 Studied puerperal (childbed)
fever
 Established that high maternal
mortality was due to failure of
doctors to wash hands after
post-mortems
 Reduced maternal mortality by
90%
 Ignored and ridiculed by
colleagues

Dr.T.V.Rao MD 2
History of infection control and
hospital epidemiology in the USA

 Pre 1800: Early efforts at wound prophylaxis
 1800-1940: Nightingale, Semmelweis, Lister, Pasteur
 1940-1960: Antibiotic era begins, Staph. aureus nursery
outbreaks, hygiene focus
 1960-1970’s: Documenting need for infection control
programs, surveillance begins
 1980’s: focus on patient care practices, intensive care
units, resistant organisms, HIV
 1990’s: Hospital Epidemiology = Infection control, quality
improvement and economics
 2000’s: ??Healthcare system epidemiology

modified from McGowan, SHEA/CDC/AHA


Dr.T.V.Rao MD
training course 3
Why do we need Infection
Control??

Hospitals and clinics are complex institutions
where patients go to have their health
problems diagnosed and treated

But, hospitals, clinics, and medical/surgical


interventions introduce risks that may harm a
patient’s health

Dr.T.V.Rao MD 4
What is Nosocomial Infection

Any infection
that is not
present or
incubating at the
time the patient
is admitted to
the hospital
Dr.T.V.Rao MD 5
Consequences of Nosocomial
Infections

Additional morbidity
Prolonged
hospitalization
Long-term physical,
developmental and
neurological sequelae
 Increased cost of
hospitalization
 Death
Dr.T.V.Rao MD 6
Florence Nightingale

It may seem a
strange principle to
enunciate as the
very first
requirement in a
hospital that it
should do the sick
no harm"
Dr.T.V.Rao MD 7
Links to the Chain of
Infection

• Portal of Entry
• Susceptible Host
• Causative Agent
• Reservoir
• Portal of Exit
• Mode of Transmission
Dr.T.V.Rao MD 8
Hospital Infections are Emerging
challenges in Health Care

Hospital-associated infections represent a serious
and growing health problem. The Centers for
Disease Control and Prevention (CDC) estimates
that 2 million people acquire hospital-associated
infections each year and that 90 000 of these
patients die as a result of their infections. A
variety of hospital-based strategies aimed at
preventing such infections have been proposed.

Dr.T.V.Rao MD 9
Modern Hospital Infection
Control

 Modern hospital infection control programs first began in
the 1950s in England, where the primary focus of these
programs was to prevent and control hospital-acquired
staphylococcal outbreaks. In 1968, the American Hospital
Association published "Infection Control in the Hospital,"
the first and only standards available for many years. At
the same time, the Communicable Disease Center, later to
be renamed the Centers for Disease Control and
Prevention (CDC), began the first training courses
specifically about infection control and surveillance

Dr.T.V.Rao MD 10
CHAIN OF INFECTION


Dr.T.V.Rao MD 11
Beginning of Accreditation

 In 1969, the Joint
Commission for
Accreditation of Hospitals--
later to become the Joint
Commission on
Accreditation of Healthcare
Organizations (JCAHO)--
first required hospitals to
have organized infection
control committees and
isolation facilities.

Dr.T.V.Rao MD 12
CDC Initiates Hospital
Infection Branch

 In 1972, the Hospital
Infections Branch at the
CDC was formed and the
Association for Practitioners
in Infection Control was
organized. By the close of
the decade, the first CDC
guidelines were written to
answer frequently asked
questions and establish
consistent practice.

Dr.T.V.Rao MD 13
First Data on Infection Control
Efficacy

 In 1985, the Study of the
Efficacy of Nosocomial
Infection Control (SENIC)
project was published,
validating the cost-benefit of
infection control programs.
Data collected in 1970 and
1976-1977 suggested that
one-third of all nosocomial
infections could be
prevented

Dr.T.V.Rao MD 14
Committee Suggested

 One infection control
professional (ICP) for every
250 beds. An effective
infection control physician.
A program reporting
infection rates back to the
surgeon and those clinically
involved with the infection.
An organized hospital-wide
surveillance system.

Dr.T.V.Rao MD 15
Infection Control Challenges of
Healthcare in 2000

 Decreasing reimbursement
 Increasing emerging infections
 Increasing resistant organisms
 Increasing drug costs
 Institute of Medicine Report--healthcare-associated infections
 Nursing shortage
 OSHA safety legislation
 Multiple benchmark systems
 FDA legislation on reuse of single-use devices

Dr.T.V.Rao MD 16
The nature of infections

Micro-organisms - bacteria, fungi, viruses,
protozoa and worms
Most are harmless [non-pathogenic]
Pathogenic organisms can cause infection
Infection exists when pathogenic
organisms enter the body, reproduce and
cause disease
Dr.T.V.Rao MD 17
Modes of spread

Two sources of infection:
Endogenous or self-infection - organisms
which are harmless in one site can be
pathogenic when transferred to another
site e.g., E. coli
Exogenous or cross-infection - organisms
transmitted from another source e.g.,
nurse, doctor, other patient, environment
Dr.T.V.Rao MD 18
(Peto, 1998)
Spread - entry and exit routes
 Natural orifices - mouth, nose, ear, eye,
urethra, vagina, rectum
 Artificial orifices - such as tracheostomy,
ileostomy, colostomy
 Mucous membranes - which line most natural
and artificial orifices
 Skin breaks - either as a result of accidental
damage or deliberate inoculation/incision (May,
2000)
Dr.T.V.Rao MD 19
HAI - common bacteria
Staphylococci - wound, respiratory and gastro-
intestinal infections
Escherichia coli - wound and urinary tract
infections
Salmonella - food poisoning
Streptococci - wound, throat and urinary tract
infections
Proteus - wound and urinary tract infections
(Peto, 1998)
Dr.T.V.Rao MD 20
HAI - common viruses

Hepatitis A - infectious hepatitis
Hepatitis B - serum hepatitis
Human immunodeficiency virus
[HIV] - acquired immunodeficiency
syndrome [AIDS] (Peto, 1998)

Dr.T.V.Rao MD 21
Components of Infection
Control Programme

 The important components of the infection control programme
are:
 ·Basic measures for infection control, i.e. standard and
additional precautions; · education and training of health care
workers; · protection of health care workers, e.g.
immunization; identification of hazards and minimizing risks;
· routine practices essential to infection control such as aseptic
techniques, use of single use devices, reprocessing of
instruments and equipment, antibiotic usage, management of
blood/body fluid exposure, handling and use of blood and
blood products, sound management of medical waste;

Dr.T.V.Rao MD 22
Need For
Control programme?

Effective work practices and procedures, such as
environmental management practices including
management of hospital/clinical waste, support
services (e.g., food, linen), use of therapeutic
devices; surveillance; · incident monitoring;
outbreak investigation; infection control in
specific situations; and research.

Dr.T.V.Rao MD 23
Developing Infection Control
Programme

Every infection control program should develop a well-
defined written plan outlining the organizational
philosophy regarding infection prevention and control.
The plan should take into account the goals, mission
statement, and an assessment of the infection control
program. It should include a statement of authority, and
should review patient demographics including geographic
locations of patients served by the healthcare system

Dr.T.V.Rao MD 24
Administrative control measures
Assignment of responsibilities
Administrator

Infection
control
nurse/Engineer

Chief doctors/ Head nurses

Personnel
Responsibility on implementing, monitoring, enforcing, evaluating, and revising
infection control programs on a routine basis including linkage to TB diagnostics 25and
Dr.T.V.Rao MD
other communicable Infections
Infection control
committee

 An infection control committee provides a forum for
multidisciplinary input and cooperation, and information
sharing. This committee should include wide
representation from relevant departments: e.g.
management, physicians, other health care workers,
clinical microbiology, pharmacy, sterilizing service,
maintenance, housekeeping and training services. The
committee must have a reporting relationship directly to
either administration or the medical staff to promote
programme visibility and effectiveness.
Dr.T.V.Rao MD 26
Prevention of Hospital
Infection-Planning
LIFECYCLE OF IC PLAN and
Implemented, monitored
enforced IC plan
Educated and trained
Develop
HCW to ensure good work
practices
Counselling and
Evaluate Revise
screening HCW
Implement periodically
Evaluated and revised
plan 4 times
Dr.T.V.Rao MD 27
The Infection Control
Team

 Consist of at least an
infection control practitioner
who should be trained for
the purpose; carry out the
surveillance programme;
develop and disseminate
infection control policies;
monitor and manage critical
incidents; coordinate and
conduct training activities.

Dr.T.V.Rao MD 28
Infection Control Committee
Purpose
Advisory

 Review ideas from infection control team
 Review surveillance data
Expert resource
 Help understand hospital systems and policies
Decision making
 Review and approve policies and surveillance plans
 Policies binding throughout hospital
Education
 Help disseminate information and influence others

29 Dr.T.V.Rao MD
Infection Control Committee -
Represented
Committee Representatives 
 Hospital Epidemiologist
 Infection Control Practitioners
 Administrator
 Ward, ICU and Operating room Nurses
 Medicine/Surgery/Obstetrics/Pediatrics
 Central Sterilization
 Hospital Engineer
 Microbiologist
 Pharmacist
30 Dr.T.V.Rao MD
Identify problems with polices and procedures
Example: Pre- and Post-Operative Care
create your protocols
Problem Recommendation
Area
 Skin shaved the night
Eliminate shaving of skin the
before surgery night before surgery
 Inappropriate peri-op Single dose peri-op antibiotic
antibiotic prophylaxis prophylaxis guidelines
 Instruments used for Use individual sterile packs of
dressing changes wound care instruments
submerged disinfectant Use small containers of
 Large containers of antiseptics; clean and dry
antiseptics, no routine for containers before refilling
cleaning and refilling
31 Dr.T.V.Rao MD
Aims of Infection Control

 To review and approve a yearly programme of activity
for surveillance and prevention; to review
epidemiological surveillance data and identify areas for
intervention; to assess and promote improved practice at
all levels of the health facility; to ensure appropriate staff
training in infection control and safety management,
provision of safety materials such as personal protective
equipment and products; and training of health workers.

Dr.T.V.Rao MD 32
Education is the Real Strength of
Infection Control programme

 Education programs for employees and volunteers are
one method to ensure competent infection control
practices. It is a unique challenge since employees
represent a wide range of expertise and educational
background. The ICP must become knowledgeable in
adult education principles and use educational tools and
techniques that will motivate and sustain behavioral
change. Much has been written about the education of
healthcare workers (HCWs).

Dr.T.V.Rao MD 33
Minimal Needs to Start
Infection Control Unit

 1 Organized surveillance
and control activities
2. One infection control
practitioner for every major
Health Facility.
3. A Trained Hospital
Epidemiologist
4. A system for reporting
surgical wound infection
rates and other infection
back to the practicing
surgeons and physicians.

Dr.T.V.Rao MD 34
GUIDELINES for Effective
Control of Infections

 Hand washing and Hospital Environmental Control

* Immunization

* Infectious Diseases Control

* Intravascular Device-Related Infections and its control

* Isolation Precautions

* Long-Term Care Facilities


Dr.T.V.Rao MD 35
GUIDELINES for Effective
Control of Infections

 * Guidelines for Infection Control in Health Care Personnel

* Surgical Site Infections Control

* Urinary Tract and Respiratory Tract Infections Control

* Ordering and Preparing Guidelines appropriately


 * Home care
 * Hospital Construction
 * Sterilization / Disinfection

Dr.T.V.Rao MD 36
Your Unwashed Hand a Great
Concern to Your Patient


Dr.T.V.Rao MD 37
Hand Washing is the Foundation
of Infection Control
 Hand washing is the single most

important procedure for preventing
nosocomial infections. Hand
washing is defined as a vigorous,
brief rubbing together of all surfaces
of lathered hands, followed by
rinsing under a stream of water.
Although various products are
available, hand washing can be
classified simply by the nature of the
products used:
 plain soap
 detergents
 Antimicrobial containing products

Dr.T.V.Rao MD 38
Hand Washing is the Foundation
of Infection Control

 Hand washing with plain soaps
or detergents (in bar, granule,
leaflet or liquid form) suspends
microorganisms and allows them
to be rinsed off; this process is
often referred to as mechanical
removal of microorganisms. In
addition, hand washing with
antimicrobial containing
products kills or inhibits the
growth of microorganisms; this
process is often referred to as
chemical removal of
microorganisms.

Dr.T.V.Rao MD 39
Hand washing Technique

 For routine hand
washing, a vigorous
rubbing together of all
surfaces of lathered hands
for at least 10 seconds,
followed by thorough
rinsing under a stream of
water, is recommended.

Dr.T.V.Rao MD 40
Hand washing

 Single most effective action to prevent HAI -
resident/transient bacteria
 Correct method - ensuring all surfaces are cleaned - more
important than agent used or length of time taken
 No recommended frequency - should be determined by
intended/completed actions
 Research indicates:
 poor techniques - not all surfaces cleaned
 frequency diminishes with workload/distance
 poor compliance with guidelines/training

Dr.T.V.Rao MD 41
Hand washing – Areas Missed
 Taylor (1978)
identified that 89% of
the hand surface was
missed and that the
areas of the hands
most often missed
were the finger-tips,
finger-webs, the
palms and the
thumbs.
Dr.T.V.Rao MD 42
Successful Promotion
in Hand Washing 

 Education
 Routine observation & feedback
 Engineering controls
Location of hand basins
Possible, easy & convenient
Alcohol-based hand rubs available
 Patient education
(Improving Compliance with Hand Hygiene in Hospitals. Didier Pittet. Infection Control and Hospital
Epidemiology. Vol. 21 No. 6 Page 381)

Dr.T.V.Rao MD 43
Successful Promotion
can Improve Hand Washing 
Reminders in theworkplace
Administrative sanctions ??
Change in hygiene agent (not in Winter)
Promote and facilitate skin care
Avoid understaffing and excessive
workload

Dr.T.V.Rao MD 44
Hand Hygiene Techniques
Many Ways

1. Alcohol hand rub

2. Routine hand wash 10-


15 seconds

3. Aseptic procedures 1
minute

4. Surgical wash 3-5


minutes
Dr.T.V.Rao MD 45
Advantages of Alcoholic Hand
Wash

 Require less time
 Can be strategically placed
 Readily accessible
 Multiple sites
 All patient care areas
 Acts faster
 Excellent bactericidal
activity
 Less irritating (??)
 Sustained improvement

Dr.T.V.Rao MD 46
Antibiotic resistance
Not a new problem - Penicillin in 1944


 Hospital “superbugs”
 Methicillin Resistant
Staphylococcus Aureus
[MRSA]
 Vancomycin
Intermediate
Staphylococcus Aureus
[VISA]
 Tuberculosis - antibiotic
resistant an Emerging
Global Concern

Dr.T.V.Rao MD 47
MRSA

 Discovered in 1981
 Found on skin and in the
nose of 1 in 3 healthy
people - symptomless
carriers
 Widespread in hospitals
and community
 Resistant to most
antibiotics
 When fatal - often due to
septicaemia

Dr.T.V.Rao MD 48
Hospital Acquired Infections and
Consequences
 Incidence of 10%

 5,000 deaths per year - direct result of HAI
 15,000 deaths per year linked to HAI
 Delayed discharge from hospital
 Expensive to treat [£3,500 extra]
 Cost to NHS - £1 billion per year
 Effective hand washing is the most effective preventative
measure
 Dirty wards and re-use of disposable equipment also blamed

Dr.T.V.Rao MD 49
The nature of infection

 Micro-organisms -
bacteria, fungi, viruses,
protozoa and worms
 Most are harmless [non-
pathogenic]
 Pathogenic organisms can
cause infection
 Infection exists when
pathogenic organisms
enter the body, reproduce
and cause disease

Dr.T.V.Rao MD 50
Staff health
Risk of acquiring and transmitting infection
Acquiring infection 
 immunisation
 cover lesions with waterproof dressings
 restrict non-immune/pregnant staff
Transmitting infection
 advice when suffering infection
Report accidents/untoward incidents
Follow local policy (May, 2000)
Dr.T.V.Rao MD 51
Waste disposal
Clinical waste - HIGH risk

potentially/actually contaminated waste including
body fluids and human tissue
yellow plastic sack, tied prior to incineration
Household waste - LOW risk
paper towels, packaging, dead flowers, other waste
which is not dangerously contaminated
 black plastic sack, tied prior to incineration
Follow local policy (May, 2000)

Dr.T.V.Rao MD 52
Spillage of body fluids
PPE - disposable gloves, apron

Soak up with paper towels, kitchen roll
Cover area with hypochlorite solution e.g.,
Milton, for several minutes
Clean area with warm water and detergent,
then dry
Treat waste as clinical waste - yellow plastic
sack
Follow local policy (May, 2000)
Dr.T.V.Rao MD 53
Standard Precautions
Hand hygiene 
Respiratory hygiene and cough etiquette
Personal protective equipment (PPE)
Based on risk assessment to avoid contact with blood, body
fluids, excretions, secretions
Safe injection practices
Environmental control
Patient placement

Dr.T.V.Rao MD 54
Nosocomial Infections are great concern in
Immune compromised Patients

Immunocompromised patients vary
in their susceptibility to nosocomial
infections, depending on the severity
and duration of immunosuppression.
Use of the two tiered system essential
to break the “Chain of Infection”.

Dr.T.V.Rao MD 55
Strengthen the Epidemiology
Epidemiology is the scientific
process applied to the
control of infections in the
healthcare setting.

Dr.T.V.Rao MD 56
Areas of interest to a hospital
epidemiologist
 Surveillance for nosocomial
infection
 bloodstream infections
  Employee health
 Disinfection and
 pneumonia sterilization
 urinary tract infections
 Hospital engineering and
 surgical wound infections environment
 Patterns of transmission of
 water supply
nosocomial infections
 air filtration
 Outbreak investigation
 Isolation precautions  Reviewing policies and
procedures for patient
 Evaluation of exposures
care

57 Dr.T.V.Rao MD
Areas of interest to a Hospital
Epidemiologist

 Antibiotic use
 Antibiotic resistant
pathogens
 Microbiology support
 National regulations on
infection control
 Infection control
committee
 Quantitative methods in
epidemiology
Dr.T.V.Rao MD 58
What is the role of healthcare
epidemiology?

Eliminate or minimize risks to a patient’s
health
organize care to minimize risk
 eliminate risk factors
 work around risk factors
 develop improved policies and procedures
educate physicians and nurses regarding
risks
study risk factors to learn more about them
and how to eliminate them
Dr.T.V.Rao MD 59
Responsibilities of the Infection
Control Program
 Surveillance of nosocomial  Education of hospital
infections staff on infection
 Outbreak investigation control
 Develop written policies for  Ongoing review of all
isolation of patients aseptic, isolation and
 Develop written policies to sanitation techniques
reduce risk from patient care  Eliminate wasteful or
practices unnecessary practices
 Cooperation with occupational
health
Dr.T.V.Rao MD 60
Key elements of surveillance


Defining as precisely as possible the event to be
surveyed (case definition)
Collecting the relevant data in a systematic, valid way
Consolidating the data into meaningful arrangements
Analyzing and interpreting the data
Using the information to bring about change

61
adapted from R. Haley
Dr.T.V.Rao MD
Areas of interest to a
healthcare epidemiologist
 Surveillance for  Employee health
nosocomial infection  Disinfection and
 Patterns of transmission sterilization
of nosocomial infections  Hospital engineering and
 Outbreak investigation environment
 Isolation precautions  water supply
 Evaluation of exposures  air filtration
 Reviewing policies and
procedures for patient
care

Dr.T.V.Rao MD 62
Organizing for Infection
Control

Requires cooperation, understanding and
support of hospital administration and
medical/surgical/nursing leadership
There is no simple formula:
 Every facility is different
 Every facility’s problems are different
 Every facility’s personnel are different
The facility must develop its own unique
program
Dr.T.V.Rao MD 63
Methods to reduce cost of
Nosocomial Infections

Reduce incidence
Reduce morbidity
Shorten hospital stay
Reduce costs of treating infections
Reduce costs of preventative measures
Stop ineffective control measures
64 Dr.T.V.Rao MD
Universal infection control
precautions

Devised in US in the 1980’s in response to
growing threat from HIV and hepatitis B
Not confined to HIV and hepatitis B
Treat ALL patients as a potential bio-hazard
Adopt universal routine safe infection control
practices to protect patients, self and
colleagues from infection
Dr.T.V.Rao MD 65
Universal Precautions
Include
 Hand washing

 Personal protective equipment [PPE]
 Preventing/managing sharps injuries
 Aseptic technique
 Isolation
 Staff health
 Linen handling and disposal
 Waste disposal
 Spillages of body fluids
 Environmental cleaning
 Risk management/assessment
Dr.T.V.Rao MD 66
Personal protective equipment
PPE when contamination or splashing with blood or

body fluids is anticipated
Disposable gloves
Plastic aprons
Face masks
Safety glasses, goggles, visors
Head protection
Foot protection
Fluid repellent gowns (May, 2000)

Dr.T.V.Rao MD 67
Personal protective equipment
PPE when contamination or splashing with blood

or body fluids is anticipated
Disposable gloves
Plastic aprons
Face masks
Safety glasses, goggles, visors
Head protection
Foot protection
Fluid repellent gowns (May, 2000)

Dr.T.V.Rao MD 68
Eliminate waste:
Unnecessary microbiologic monitoring

Routine environmental cultures of walls, floors, air,
sinks, or other hospital surfaces
Routine cultures of healthcare workers nose and hands
Clinical cultures which are not available to clinicians in
time to help with decision making
Also: Failure to generate annual summary of culture data to
provide clinicians with data for empirical selection of
antibiotics

69 Dr.T.V.Rao MD
Practice Aseptic techniques

Sepsis - harmful infection by bacteria
Asepsis - prevention of sepsis
Minimise risk of introducing pathogenic
micro-organisms into susceptible sites
Prevent transfer of potential pathogens
from contaminated site to other sites,
patients or staff
Follow local policy (May, 2000)
Dr.T.V.Rao MD 70
Antibiotic Prophylaxis in
Surgery

 Potentially an important part of surgical wound infection
prevention
 May also be a significant expense for the hospital
 What is the cost-benefit of prophylactic antibiotics?
 What is cost of wound infection? In money? In
suffering?
 How effective is prophylaxis?
 How much can we spend to prevent a case of wound
infection ?

71 Dr.T.V.Rao MD
Sharps injuries
Prevention 
correct disposal in appropriate container
avoid re-sheathing needle
avoid removing needle
discard syringes as single unit
avoid over-filling sharps container
Management
follow local policy for sharps injury (May, 2000)

Dr.T.V.Rao MD 72
Protecting Yourself from
Blood-Borne Pathogens


Dr.T.V.Rao MD
HIV: 3 Infections per 1,000 Sticks with a
HIV+ Needle


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Dr.T.V.Rao MD
Hepatitis C: 18 Persons per 1,000
Needle-sticks

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Dr.T.V.Rao MD
Hepatitis B is Most Infectious

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Dr.T.V.Rao MD
Protect Yourself! Get a Hepatitis B Vaccination
and keep your Vaccine Record

 3 doses of Hepatitis B
vaccine protect most
people for a lifetime in
Majority of Indivuasls
 But HCW blood banks,
and dialysis should
follow the updated
Instructions
 The next dose at this
facility will be given on

Dr.T.V.Rao MD Slide 77
Safe Handling of Sharps
 Wear gloves when drawing

blood or handling sharps—
double glove for surgery
 Don’t recap!
 Don’t bend or break needles
 Never place used sharps on
tables, beds, furniture
 Put used sharps
immediately into a sharps
container

Dr.T.V.Rao MD 78
Disposal of Sharps: The Ideal

Immediately after
use, put sharps in a
leak- proof and
puncture-proof
container
The container should
be within arm’s
length
Sharps Disposal (cont’d)

 Disposal containers should be placed at all points
of use
 Disposal bin should be rigid and should be leak and
puncture proof
 Separate sharps from other waste so laundry workers or
waste disposal staff do not get needlesticks

 Empty sharps containers when they are ¾ full

Dr.T.V.Rao
Slide 80MD
Danger!
Open containers of
used needles like this
put staff at risk each
time they put a hand
in to pick up one
Keep your ward free
of used sharps
Remember this Procedure…
When Injures with a Needle

If a needle pricks you or blood and/or body
fluids
enter your eye(s) or mouth
Wash wounds with soap and water
Flush eyes and mouth with water
Check the patient record to see if the patient is HIV+,
HIV- , or untested
Check patient record for Hepatitis B or C infection
Call the medical duty officer
Slide 82MDimmediately
Dr.T.V.Rao
Protecting Yourself from Blood-Borne
Pathogens (cont’d)
Wear gloves
Dispose of sharps
immediately after use to
Don’t recap needles
minimise handling that
Complete 3 doses of increases risk of
Hep B vaccine needlesticks
Eliminate Substitute safer devices
unnecessary injections or tools whenever
possible
Report needlesticks
Dr.T.V.Rao
Slide 83MD
Prion diseases

 Prions [“pree-ons”] - proteinaceous infectious particles
 Corrupted form of a normally harmless protein found in
mammals and birds
 Causes fatal neurodegenerative diseases of animals and
humans
 Animals: scrapie - sheep, bovine spongiform
encephalopathy [BSE or Mad Cow Disease]
 Humans: Creutzfeldt-Jakob disease [CJD]
 Prions found in blood, tonsil and appendix tissue

Dr.T.V.Rao MD 84
Prions and surgery

Prions cannot be
destroyed by
sterilisation
Theoretical risk of
cross infection from
contaminated
instruments and
blood transfusion
Dr.T.V.Rao MD 85
Wish to be Better Informed Internet
sites

http://www.icna.co.uk/
http://www.nursing-standard.co.uk/
http://www.medscape.com/
http://www.anes.uab.edu/medhist.htm
http://www.shef.ac.uk/~nhcon/
http://medweb.bham.ac.uk/nursing/
http://www.healthcentre.org.uk/hc/library/defa
ult.htm
Dr.T.V.Rao MD 86
Resources: Where to get more
information or help
 Training Courses

 Society of Hospital Epidemiologists of America (SHEA)
 Association of Professionals in Infection Control (APIC)
 National courses and congresses
 Books
 Textbooks: Bennett and Brachman - Wenzel - Mayhall
 APIC Curriculum and Guidelines
 CDC Guidelines
 Journals
 Infection Control and Hospital Epidemiology
 Journal of Hospital Infections
 American Journal of Infection Control
 Consulting services
 National: CDC, Ministry of Health
 Colleagues
Dr.T.V.Rao MD 87

Created by Dr.T.V.Rao MD for ‘e’
Learning resources to Medical and
Paramedical Health Care Workers in
the Developing World
Email
doctortvrao@gmail.com
Dr.T.V.Rao MD 88