TROPICAL MEDICINE Infection Prevention and Control in the Tropics Ana Maria Gomez J. MD. Msc. PhO(c) Faculty of Medicine UDLA 1. Introduction 2. Basics of Infection Control 3. Infection Control practices to decrease the risk of Infection Transmission 3.2 Standard Infection Control Practices 3.1 Transmission-Based Precautions for Prevention of Infection 4. Surveillance for health care - associated infections 5. Special problems of the TropicsIntroduction Tropical Diseases - control - prevention - elimination Infection control policies and procedures: to prevent patients, health care workers from acquiring infections. Environmental and climate conditions create infection control challenges unique to the tropics Tropical climates are warm and humid, with . environmental pollution (urbanization, industrial Introduction wastes, and air pollution) leading to higher vector densities and communicable disease outbreaks. Furthermore, the tropics roughly coincide with low- index countries, adding resource constraintsBasics of Infection control Tropical Diseases - control - prevention - elimination © The goal of infection controls to prevent and control HAls within hospital or clinical practice settings. . . Infection risk assessment Infection Detecting and managing outbreaks Controlling antimicrobial use and stewardship, Liaising with other hospital departments or control HA committees to implement safety standards Educating all staff and affecting behavioral change. setti ng An “infection control committee” should be established to oversee compliance, efficacy, and adequacy of infection control measures and to develop institution-specific guidelines.Basic Infection Control Measures for Health Fat Sureeillance, either hospital-wide or targeted Hand hygiene Outbreak investigations Cleaning, disinfection, and sterilization of equipment and disposal of infectious waste Hospital employee health, specifically after exposure to either blood-borne or respiratory pathogens Review of antibiotic utilization, its relationship to local antibiotic resistance pattems, and antibiotic stewardship programs Prevention of infections due to surgical procedures and invasive devices (e.g., central venous catheters, urinary catheters, and ventilators) Development of infection contro! policies and procedures Transmission-risk based patient isolation Oversight on the use of new products that directly or indirectly relate to the risk of health care-associated infections Infection control practices to q decrease the risk of y infection | transmission Tropical Diseases - control - prevention - eliminationDroplets Infected : . wea jusceptible inde a ACA Standard infection control precautions (“Standard Standard Precautions”) apply to all patients, regardless of their reason for admission or infection status. infection The most important element is hand hygiene (handwashing with soap and water or alcohol-based gels or foams) control Guidelines published by the HICPAC/SHEA/APIC/ IDSA Hand Hygiene Task Force . pra ctices Alcohol-based hand rubs can be used where there is limited access to water. They have better acceptability, less skin irritation, and quicker application compared with soap and water, resulting in improved compliance. Commercially prepared products available: low-cost gel (20 ml of glycerin, propylene glycol, or sorbitol mixed with 980 mL of >70% isopropanol). Gels combining chlorhexidine and alcohol (expensive).“TABLE 20.1 Componente of Standard infacton Control Precautions ‘Component Recommendation Hand tygene ‘Eneloy ale fouching bod, body fics, sarelons, covaranaied Ears; Finale ater ranowry Geves, batisen patent contacts Personal orotate ‘caupment PPE) Ges For touching blood, body Nc, secrtions, contamrated lms; fr touching mucous memrares and ron-tact sn Gowns During proced.rs end patent care actifes when contact with cothing/exposed skin wih tcodTbody fukis. secretions i ‘aniipatoc Mack @ye protection Dung precede and patent care actites when contact wth cotinglexposed skin wrth bcodIbody fue, secretons anibipated Sold palert cae —__‘Hando ina marner the prevents Vansir of ricooraarisms to others and to the environment. wear doves if vty ‘equpment {contaminated pare hand hygiene Envronmartal onal Bevel proadues or route cae, Gani, and Gaifoctin of ervorental suas, especly Waquerly touched ‘sudaces pation care areas “Toios andilaundry __Hando in a manner that proven tancfor of ricroorgarieme 6 othore and tothe ondrenmont ag nen st pon! of depeal rio 2 rocopeace, and pase sotod ren leak-proof bao TNewdes and other Do not racap, bend, beak, or hane-manpulle used needs: recaophg i reqied, use a one-handed soaop leche sharps: ‘oni: use calety features when avalable: piace used shar fh puncture resistant contaner Patent placorent Profi for englo-patent reom if palert st rereased rick of tranemsicn of nfecon, «© lay to conlamrata the ‘hvtenmnere, doesnot main approprate Fyne, sat inreased isk of acaulrhg fection of Geveoping an ackerse outcome afer nection Rorpraloy hygone” __ ineruct eymolorrte parse to ooverrouthinoss when sneaang/coughing, ube Hesuce ond depose h no touch ‘cough etiquette ‘ecoptaie; hand rygiae afr salng hards wth respratory seerstons| wear sugea rresk trated or martan spatial senmration 3 ft possible “Adepied wor Sigel JO, Phinahar , Jackson M, eta Hasthiowe Irfecton Contol Practeas Advisor) Ganmiiee 007 guidane fer wolaion ‘recautone: Preven warsmisson of rfectous agents in healthcare setings, Febuary 2017 ip. oc govinsdoa/chapralisoalion (eccessed sine 4.2017) ‘TABLE 20.2 Modes of Transmission in Health Care Settings Features Most commen route. Divided into two sub- Cogancns ar tanctec rom ono nected set, Person to another winout a contaminated Transmission- intermediate, e.., body hid of patent crecty tnters health care worker's bod tough mucous mambrane or cut in sn. Based Precautions ‘Tranetor of organism tough a eontarinatod intermediate object or person. Important for Prevention of otoe peter ews uenes and instruments, nd clothing i spiatory droplets 5 um) cary organssms Infection rectly irom the respratory tact of the patent over short dstances (usually < fee), necesstatng facial protection such as with mmesks: a.g., Bordofola pertusss, Mycoplasma ‘pnoumoniae, resprtory synoytal virus, and rfluenza ves, Transrission of droplet noc ( wr) or small parides containing infectous agents that Terai infective overtime and distance, 8.2, Mycobacterium tuberculoss, measles vis, vericella-zoster vius, These necessitate use of Special ar handing and vertiaion systems.© SURVEILLANCE FOR HEALTH CARE- ASSOCIATED INFECTIONS Tropical Diseases - control - prevention - elimination Extraction of EHR otal patonts acted code ‘ing a Spectod perioRisk Factors for Health Care-Associated Infections in Developing Countries ae ering te, 2p, acco Components of Surveillance = COLLECTING DATA Concurrent — epidemiology staff collect data at the time the event occurs and shortly thereatter ~ this allows infection control staff to review the medical record, assess the patient, and discuss the event with care givers ~ additional information may be available, such as ward log books and nursing reportsInfection Control Benefits BP EPO Hand Hygiene Contact Medical Scope Environmental Surgical Sterile Compliance Tracing Management ‘Management ‘Monitoring Processing Special problems of the tropics Tropical Diseases - control - prevention - eliminationSpecial problems of the tropics ee AMO A ore Oona eto Ne in te rece EW So cesar eee ei ectnioe Tuberculosis* Pee akon le Aree io eeu ena noe 8. Surgical Site infections 9. Unsafe Injections and Needle sticks injuries SOS tessa ater Sern ee e. Crossover ‘ community | -¥ infections into y Hospital Several recent outbreaks in the tropics have mandated development of infection control strategies specific to transmission dynamics of infectious agents(Fo, 281 Hci ies outa xk ote raed fo 2013 020 ‘Resa testn oan ony, Geel az vera Ebola Virus Ecology and Transmission Ebola virus disease is a zoonotic disease. Zoonotic di Animalto Rain lnsaniales Evidence suggests that bats ae the Feservor host or the Ebola us. Bats carrying the vius can transit it feather gnimsl ke 9pez monkeys kes anelopesh, os well 510 Spillover Event ‘pifove event” occu wh ‘imal (ba. ape, monte, human becornes infected wt Vitus though conc with the Teservoirhost This contact could tera tvaugh hunting of preparing ‘he animals mest for eating repre oa year 93+ involve animals and humans, Humen-te-Human Tensmission ‘pce the Ebola _— ha infected i, Unprotected healthcare worker ‘muscle aches and ease 2 thay re eget thy comma