J.M.

, a 30-year-old nurse in a tertiary hospital

was admitted with a chief complaint of
jaundice. History revealed constitutional
signs & symptoms of fever, weight loss,
anorexia, body malaise, tea-colored urine
& acholic stools. During the course in the
wards, patient was diagnosed to have
Hepatitis B infection. On further
questioning, patient claimed to have had a
needle stick injury 2 months ago while
recapping a syringe that was used to a
patient under his care. Apparently, the
nurse disregarded the incident.

What went wrong???

No

universal precaution practice

No report of the incident

UNIVERSAL
PRECAUTION

 1987,

the Centers for Disease Control

& Prevention (CDC) instituted
universal precautions
Principle: all clients are considered to
be possible carriers of bloodborne
pathogens
Recommendations:
Wear

gloves when collecting or handling

body fluids contaminated with blood
Wear face shields when there is danger
of blood splashing on mucous
membranes
Dispose all needles & sharp objects in
puncture-resistant containers

Flawless?

CDC

excluded urine & body fluids not

grossly contaminated with blood

Body substance isolation

CDC

modified the universal

precaution to BSI
BSI not limited to bloodborne
pathogens
Considers all body fluids & moist
body surfaces to be potentially
infectious
Recommendation:
> all healthcare personnel should
wear personal protective equipment
at all times when encountering moist

Almost Perfect!
Major

disadvantage of BSI guideline:

it does not recommend handwashing

following the removal of gloves unless
visual contamination is present

Standard Precaution
1996,

CDC combined major features

of UP & BSI
Standard precaution guidelines stress
patient contact, however, these can
also be applied to patient specimens

SP Guidelines
1.
2.
3.
4.
5.
6.
7.
8.
9.

Handwashing
Use of gloves
Use of mask, face shield
Use of gown
Patient-care equipment
Environmental control
Linen
Occupational health & bloodborne pathogens
Patient placement

Handwashing

Wash hands after touching blood, body fluids,

secretions, excretions, & contaminated items,
WHETHER OR NOT GLOVES ARE WORN
Wash hands immediately after gloves are
removed, between patient contacts
Wash hands between tasks & procedures on the
same patient to prevent cross-contamination of
different body sites
Use plain soap for routine hand-washing
Use antimicrobial agent or a waterless antiseptic
agent for specific circumstances
After hand-washing, ensure that hands do not
touch potentially contaminated environmental
surfaces or items in the patients room to avoid
transfer of microorganisms to other patients

Gloves

Wear gloves when touching blood, body

fluids, secretions, excretions, &
contaminated items
Change gloves between tasks &
procedures on the same px after contact
with material that may contain a high
concentration of microorganisms
Remove gloves promptly after use, before
touching non-contaminated items &
environmental surfaces, & before going to
another patient

Mask, Eye Protection, Face

Shield
> Wear mask, eye protection or face
shield to protect mucous membranes
of eyes, nose, and mouth during
procedures & patient-care activities
that are likely to generate splashes
or sprays of blood, body fluids,
secretions & excretions

Gown
Wear

gown to protect skin & prevent

soiling of clothing during procedures
& patient-care activities that are
likely to generate splashes or sprays
of blood, body fluids, secretions &
excretions
Select a gown that is appropriate for
the activity & amount of fluid likely to
be encountered

Environmental Control
> Ensure adequate procedures for the
routine care, cleaning, & disinfection
of environmental surfaces, beds,
bedrails, bedside equipment, & other
frequently touched surfaces, &
ensure that these procedures are
being followed

Linen
> Handle, transport, & process linen
soiled with blood, body fluids in a
manner that prevents skin & mucous
membrane exposures &
contamination of clothing

Patient Placement
Place

a patient who contaminates

the environment or who cannot be
expected to assist in maintaining
appropriate hygiene in a private
room
Consult with infectious control
committee regarding patient
placement if a private room is not
available

Occupational health &

bloodborne pathogens

Observe measures to prevent injuries

when using needles, scalpels, & other
sharp instruments when cleaning or
disposing
Never recap used needles
Place sharps in puncture-resistant
containers
Use mouthpieces, resuscitation bags as an
alternative to mouth-to-mouth
resuscitation

Philippine Setting
Standard

precaution

Too good to be
true!!!

Infection Control Committee

Multidisciplinary representation from different

relevant sections
Direct relationship with administration & staff
Directs the infection control program
Communicates & works with other committees
Members:

Chairman responsible for the effective implementation

of ICC policies
Consultant Pathologist
Consultant in Infectious diseases
Nurse with training in infection control
Representatives from different clinical departments

Pediatrics, Internal Medicine, surgery etc

Dietary services
Housekeeping
Engineering/maintenance
Central sterile supply
Pharmacy

Function of ICC
Responsible

for day-to day infection

control, including advice on preventive
measures
Investigates outbreaks of infection
Organize Major outbreak committee to
investigate & terminate outbreak
Collaborates with other hospital
departments & community
Inform patients & relatives of situation
Contacts the department of health in case
of notifiable disease
Informs adjacent hospitals & media if
necessary

Algorithm
Management of Infection
City Health Officer/DOH
Hospital Director/Director of ancillary services
Infection Control Committee
Major outbreak committee
(Infection control professionals + Attending MDs of
patient)

Individual Roles in Infection

Control
Hospital Administration
Create an infection control
committee
Identify resources available
Ensure adequate education &
training
Delegate duties & responsibilities
Assure infection control service
authority

Individual Roles in Infection

Control
Physicians
Serve or support the ICC
Practice infection control principles

Individual Roles in Infection

Control
Microbiologist/Medical Technologist
Maximize procedures to obtain
microbiological diagnosis
Maintain standards in the lab
Provides guidelines
Ensure safe lab procedures

Individual Roles in Infection

Control
Pharmacist
Proper storage, handling & care of
supplies to prevent contamination &
ensure drug potency
Reports on trends of antibiotic use
Gives information on drugs
Participates in hospital activities
related to use of disinfectants

Individual Roles in Infection

Control
Nursing Staff
Participates in the infection control
committee
Training of nursing staff
Implements infection control policies
Initiates isolation procedures as
needed
Limits exposure of patient &/or visitor
from source of infection

Individual Roles in Infection

Control
Central sterilization services
Collaborates with ICC in developing &
monitoring policies on sterilization &
disinfection
Ensures proper maintenance of
equipments & supplies
Reports problems to ICC

Individual Roles in Infection

Control
Food/Dietary Service
Sets criteria in the purchase,
handling & storage of foodstuffs
Ensures cleanliness
Promotes handwashing, good
grooming & disinfection among its
staff
Trains staff
Promotes proper waste management

Individual Roles in Infection

Control
Linen/Laundry service
Applies policy on handling linen
Ensures adequate supply of clean
linen
Ensures safety of its staff
Develop criteria for use of
equipments in its area

Individual Roles in Infection

Control
Housekeeping
Provides proper cleaning services
Assures proper waste management
Maintains adequate supplies of
disinfecting materials
Reports problems for repair
Pest control & plant care

Individual Roles in Infection

Control
Maintenance/Engineering
Maintains, repairs & helps in
selecting equipments
Ensures safety in the environment
Inspects environment for repair
needs
Notifies concerned area for any
maintenance problems

Prevention of Nosocomial
Infection
Requires

an integrated, monitored
program which includes:
Breaking

the weakest link in the chain of

infection (mode of transmission)
Controlling environmental risks for
infection
Protecting patients with appropriate use
of prophylactic antimicrobials, nutrition
& vaccination

Prevention of Nosocomial
Infection
Limiting

the risk of endogenous

infections by minimizing invasive
procedures & promoting optimal
antimicrobial use
Surveillance of infections, identifying
& controlling outbreaks
Prevention of infection in staff
members
Enhancing staff with patient-care
practices & continuing staff

Risk Stratification
Acquisition

of nosocomial infection is
determined by:
Patient

factors (degree of susceptibility)

Interventions performed
Level

of patient-care practice may

differ for patient groups
Risk assessment will be helpful to
categorize patients & plan of
infection control & intervention

Risk stratification
Risk of Infection

Type of Patients

Type of Procedures

1
Minimal

Not
Non-invasive
immunocomrpomise No exposure to
d
biological fluids
No significant
underlying disease

2
Medium

Infected Patients or
patients with some
risk factors

3
High

Severely
Surgery or high-risk
immunocompromise invasive procedures
d patient, multiple
trauma, severe
burns, organ
transplant patients

Exposure to
biological fluids or
invasive nonsurgical procedure

Preventing Infections Among Healthcare workers

(Philippine Setting)

Personnel education is a cardinal element of an effective

infection control program
Infection control education should be modified accordingly
Monitor & investigate outbreaks among personnel
Care for work-related exposures
Measures to limit further transmission of infection
Work restrictions
Provide post-exposure prophylaxis

Infection risks & preventive measures

Immunization programs should be included to newly hired &
current employees
All healthcare personnel should be educated about infection
control policies & procedures

Risk of Healthcare Workers

Contaminated

needlesticks, sharps,
or splash exposures
part of the job
Risk of infection from bloodborne
pathogen

Risk of Healthcare Workers

Annually,

healthcare workers
experience between 600,000 to
800,000 exposures to blood
Exposures carry risk of infection with
HIV, HBV, HCV
At least 1,000 HCWs are estimated
to contract serious infections
annually from needlestick & sharp
injuries
Only the tip of the iceberg

What to do after needlestick or

sharps injury?
Wash,

flush or irrigate
Alert your supervisor and fill up an
exposure report form
Identify the source patient
Determine status of patient
Report to ER
Perform tests: HIV, HBV, HCV