Special Populations Learning objectives - PowerPoint Presentation

1. Special Populations

2. Learning objectivesIdentify special populations and their specific featuresDescribe specific risk factors of each special population that make it vulnerable to healthcare-associated infections For any special population, outline additional methods for the prevention of healthcare-associated infections December 1, 20132

3. Time involved60 minutesDecember 1, 20133

4. Special populationsGeriatricsPaediatricsBurnsBehavioural healthAmbulatory/Community careImmunocompromised populationsEndoscopyDecember 1, 20134

5. Basic Infection Prevention and Control (IP&C) StrategiesHand hygieneStandard precautions/routine practicesIsolation/precautionsStaff educationAseptic techniquesVaccination December 1, 20135

6. Geriatrics - 1 Susceptibility of the elderly to infection is a result of underlying illnessmultiple medicationsalterations in immune function Residents of nursing homes or long-term care facilities are particularly at riskDecember 1, 20136

7. Geriatrics - 2Most frequent problemsRespiratory tract infectionsUrinary tract infectionsGastrointestinal infectionsSkin and soft tissue infectionsDecember 1, 20137

8. Geriatrics – Respiratory Risk FactorsSwallowing disorders or poor gag reflex with aspirationImpaired mucociliary clearanceIncreased esophageal refluxImmobilityDehydrationDecember 1, 20138

9. Geriatrics – Skin Risk FactorsChronic oedemaVenous insufficiencyUnrecognised traumaDiabetes mellitusDry skinDecember 1, 20139

10. Geriatrics – Diarrhoea Risk FactorsA significant cause of morbidity, particularly in institutionalised older persons. Pathogens may be spread by ingestion of microorganisms or toxins from an infected personcontaminated food or watercontaminated objects in the environment, or infected animalsDecember 1, 201310

11. Preventing infectionsInfectionPreventionUrinary tract infectionAdequate hydrationGood personal hygieneMobilisationAvoid bladder cathetersBronchitis and pneumoniaVaccination Cohorting patients with respiratory illnessLimiting group activities and communal dining during influenza outbreaksMobilisationAdequate hydrationPressure ulcers Mobilisation Keeping the patient dry Providing nutritional support Using antipressure devicesDiarrhoeal illnessesEarly implementation of cohorting or room closure Reinforcement of environmental disinfection Hand hygieneIsolation precautionsDecember 1, 201311

12. Paediatrics Youth and immature immune systems make children more susceptible to infectionsClose contact with patients, siblings and family, uncontrolled body fluids, and play areas create unique opportunities for the spread of infectionDecember 1, 201312

13. Paediatrics - RisksChildren at higher risk for infectionsthose in intensive carepatients with cancersolid organ transplant and haematopoietic cell transplantation recipientsneonatesDecember 1, 201313

14. Paediatrics – PreventionInfection/RisksPreventionCommunicable diseasesVaccinate according to national guidelinesBreast milk and infant formulaMothers should be instructed on hygienic methods Proper cleaning and disinfection of breast pumpsToys Frequent cleaning of toys and environmentAvoid high-risk toys, such as soft/stuffed toys, that are difficult to clean and dryViral respiratory and gastrointestinal illnessesPatients should be screened; isolation/precautions initiated while awaiting a diagnosis. December 1, 201314

15. BurnsHave a major impact on cellular and humeral immune systems; predispose patients to infection Burn causes mechanical disruption of the skin; allows skin and environmental microbes to invade deeper tissues As burn size increases, the risk of infection increasesDecember 1, 201315

16. Burns – Prevention- 1Strict aseptic techniqueUse of sterile gloves and dressing materialsWearing masks for dressing changesSpatial separation of patients, either using single rooms or cubicles December 1, 201316

17. Burns – Prevention - 2Hand hygiene before and after patient contactStandard precautions/routine practicesProtective apparel (aprons, gowns) before each patient contactChanging gloves when soiled and before continuing with care at another site on the same patientCleaning and disinfection of reusable equipment before use on another patientDecember 1, 201317

18. Burns – Prevention - 3Restrict plants and flowers at the bedsideRestrict non-washable toys (stuffed animals, cloth objects) for paediatric burn patientsPlace catheters through unburned skin or frequent change of the catheter to decrease risk of infectionDecember 1, 201318

19. Burns – Prevention - 4Isolate patients colonised with multiply resistant microorganisms in single rooms or cubiclesHydrotherapy used routinely in some facilities; has been associated with outbreaksSome prefer to use local wound care with sterile saline solution instead If hydrotherapy used, shower tables are less risky than immersionRinse the tanks or equipment with sodium hypochlorite after each useDecember 1, 201319

20. Behavioural Health Behavioural health care provides prevention, intervention and treatment services in these areasMental health, Substance abuse Development disabilities SexualitiesDecember 1, 201320

21. Behavioural Health - Prevention - 1Practice standard precautions/routine practicesStaff working with children vaccinated for typical childhood illnessesInpatient influenza and pneumococcal immunisation program for adults; children up-to-date on immunisationsDecember 1, 201321

22. Behavioural Health - Prevention - 2Prevent mixing of patient clothing; special consideration for clothing of patients with incontinence, wound infections, or lesions, and suspected or confirmed cases of scabies or lice Provide patients with a caddy or basket to keep personal toiletry items if they share a bathroomDisposable paper mats for individual shower use; protect from transmission of athlete’s foot (Tinea pedis)December 1, 201322

23. Behavioural Health - Prevention - 3Lice and scabies procedures Identification of illnessMonitoring for transmissionTreatment (includes staff monitoring of the application of treatment) and follow-upHousekeeping proceduresDecember 1, 201323

24. Behavioural Health - Prevention - 4Provide disposable razors for shaving; discard after use in an appropriate sharps containerIf electric shavers provided, have a protocol for cleaning and disinfecting the shaver after use For electroconvulsive therapyHand hygieneUse of glovesCleaning and disinfection of equipmentBite blocks and laryngoscope blades require high-level disinfectionDecember 1, 201324

25. Ambulatory/Community Care Provision of health care to patients who do not remain overnightPhysician’s surgeriesClinics Dental surgeriesDiagnostic treatment centresPhysical and occupational therapy centres December 1, 201325

26. Ambulatory/Community Care Overall risk of HAIs lower in ambulatory/community settings than in hospitalsVisits are brief, environmental contamination lower, less invasive procedures performed, and population healthier Risks: waiting areas, proceduresDecember 1, 201326

27. Ambulatory/Community Care Infection/RisksPreventionRespiratory illnessRespiratory hygiene / respiratory etiquette Communicable diseases (tuberculosis, chickenpox, measles, mumps, rubella, bacterial meningitis)Wear a surgical mask and place in a separate room with the door closedToys Limit sharingEasily cleanableInstrumentsClean, disinfect/sterilise properly; use of safer devices to reduce the risk of needle-stick injuriesDecember 1, 201327

28. Immunocompromised Populations - 1Severe neutropenia of treatment regimens and certain underlying diseases, and invasive devices and procedures, result in a high frequency of infection in these patientsDecember 1, 201328

29. Immunocompromised Populations - 2Four broad categories of risk factors: Neutropenia (granulocytopenia)Immune system defectsDestruction of protective barriers, e.g., skin and mucous membranesEnvironmental contamination/alteration of microbial floraDecember 1, 201329

30. Immunocompromised Populations - RisksVentilationConstruction/renovationEquipmentPlantsPlay areas and toysHealth-care workersVisitorsSkin and oral careDecember 1, 201330

31. Immunocompromised Populations – Prevention - 1 Patient-focused Good oral and dental hygiene importantoral cavity a reservoir for microorganisms severe mucositis predisposes the spread of microorganisms into the bloodstreamPatients and family members, as well as healthcare workers, should be taught the importance of hand hygieneDecember 1, 201331

32. Immunocompromised Populations – Prevention - 2Staff-visitor-focused Screening programs for communicable infections, especially during the appropriate “seasons” for certain illnessesRestrict from direct patient care activities all healthcare workers with communicable infectionsDecember 1, 201332

33. Immunocompromised Populations – Prevention - 3Environment-focused Isolation/precautions techniques are debateable; there are insufficient data to recommend the use of additional protective precautionsPrevent dust accumulation with daily cleaning of frequently touched horizontal surfacesAvoid cleaning methods that generate dustClose doors to patient rooms while any vacuuming takes place nearbyExclude plants and flowers Clean toys regularly and when visibly soiled or mouthedAvoid toys that cannot be washed or disinfected after use Immunocompromised patients should avoid construction or renovation areasDecember 1, 201333

34. EndoscopyRisks due to the complexity of the instrumentsMicroorganisms contaminating the equipment might be introduced into the patient, or patient’s own microorganisms may be spread by the endoscope (rare) Outbreaks have been caused by inadequate cleaning/disinfection of endoscopes or accessories between patientscontaminated water rinses or contaminated automatic endoscope reprocessorsDecember 1, 201334

35. EndoscopesInternal channels for air, water, aspiration, and accessories exposed to body fluids and other contaminantsCleaning is critical Six steps for re-processing: CleaningRinsingDisinfectionRinsingDryingStorage December 1, 201335

36. Endoscopy Protocols - 1Set-upEndoscopic procedure room designated as clean areasSeparate contaminated areas where accessories and specimens are handled from clean counter areasCleaningManual cleaning important; include brushing, using a medical grade, low-foaming, and neutral pH detergent Use automatic disinfection, rinsing, and drying of all exposed surfaces of the endoscope, when available. Water for automatic endoscope reprocessors should be free from particles and microorganisms.Isopropyl alcohol for flushing endoscope channels as part of the drying process December 1, 201336

37. Endoscopy Protocols - 2Use single-use accessories when possible Discard rubber valves covering the working channel after procedures involving the passage of biopsy forceps, guidewires, and/or other accessoriesDecember 1, 201337

38. Key Points Basic infection prevention strategies apply, regardless of patient type or settingAdditional strategies may be required for special populationsStrategies designed for hospitals may need adapting for other health care settingsDecember 1, 201338

39. Additional Reading - 1Geriatrics: SHEA/APIC Guideline: Infection prevention and control in the long-term care facility, 2008. http://www.apic.org/Content/NavigationMenu/PracticeGuidance/APIC-SHEA_Guideline.pdf Endoscopes: Multisociety guideline on reprocessing flexible gastrointestinal endoscopes: 2011. http://www.asge.org/uploadedFiles/Publications_and_Products/Practice_Guidelines/Multisociety%20guideline%20on%20reprocessing%20flexible%20gastrointestinal.pdf and WGO-OMGE and OMED Practice Guideline: Endoscope Disinfection, 2005. http://www.omed.org/downloads/pdf/guidelines/wgo_omed_endoscope_disinfection.pdfDecember 1, 201339

40. Additional Reading - 2Burns: European Practice Guidelines for Burn Care, 2002. http://www.euroburn.org/e107_files/downloads/guidelinesburncare.pdfAmbulatory care: Infection Control Manual for Ambulatory Care Clinics, Texas Department of State Health Services, 2009. http://www.dshs.state.tx.us/idcu/health/infection_control/manual/InfectionControlManual.pdfDecember 1, 201340

41. Additional Reading - 3Immunocompromised: Guidelines for Preventing Infectious Complications among Hematopoietic Cell Transplantation Recipients: A Global Perspective. Biol Blood Marrow Transplant 15: 1143-1238 (2009). http://www.shea-online.org/Assets/files/guidelines/2009_HSCT_Guideline.pdfDecember 1, 201341

42. QuizMobilisation of older patient is important measure in prevention of urinary tract and respiratory tract infections and pressure ulcers. T/FSpecific measures for prevention of burn wound infections include:Hand hygiene before and after patient contactFrequent change of vascular catheters in some circumstancesDisinfection of hydrotherapy tanks with sodium hypochlorite solutionAll of the aboveDestruction of protective skin barriers is a risk factor for highly immunocompromised patients. T/FDecember 1, 201342

43. International Federation of Infection ControlIFIC’s mission is to facilitate international networking in order to improve the prevention and control of healthcare associated infections worldwide. It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe . The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication, consensus building, education and sharing expertise. For more information go to http://theific.org/December 1, 201343