Immunization, vaccination programs
and immunization schedule
SU Dept. of Public Health
History of vaccination I.
• Variolation: against
smallpox 10th or 11th
century in Central Asia
(India)
• 1796: Jenner used
cowpox inoculation to
prevent smallpox
(immunization)
Edward Jenner
(May 17, 1749 – January 26, 1823)
SU Dept. of Public Health
SU Dept. of Public Health
History of vaccination II.
• Works with anthrax and
chicken cholera, developing
artificially weakened
microorganisms
• He gave the name
vaccination (Vacca - cow in
Latin) to honour Jenner’s
work.
• July 6, 1885: First rabies
vaccination on a nine-year
old boy (with Emile Roux)
Louis Pasteur
(December 27, 1822 – September 28, 1895)
SU Dept. of Public Health
History of vaccination III.
• Tetanus – first vaccine in
1890
• BCG (Bacillus CalmetteGuérin) – vaccine against
tuberculosis. First used in
humans in 1921, but
widespreaded only after
World War II.
• Diphtheria – first successful
vaccine in 1923
• Pertussis – first successful
vaccine in 1925 by Thorvald
Madsen
Léon Charles Albert Calmette
(July 12, 1863 – October 29, 1933)
Jean-Marie Camille Guérin
(December 22, 1872 - June 9, 1961)
SU Dept. of Public Health
History of vaccination IV.
• DTP vaccine by Kendrick –
1942
• Polio vaccine by Salk – 1952
• Polio vaccine by Sabin –
1961
• Measles – 1963
• Mumps – 1967
• Rubella – 1970
• Hepatitis B – 1981
• Haemophilus influenzae B –
1985
Jonas Edward Salk
(October 28, 1914 – June 23, 1995)
Albert Bruce Sabin
(August 26, 1906 - March 3, 1993)
SU Dept. of Public Health
The benefit of vaccination I.
Smallpox eradication
• 1958: Soviet Union calls for
eradication (2 million death / year)
• 1967: WHO team formed
• Quaranteene vaccination
• 1975: Last variola major case in
Bangladesh
• 1977: Last variola minor case in
Somalia
• 1979: The world is officially
smallpox-free
• 2004: Bush vaccinates himself
SU Dept. of Public Health
The benefit of vaccination II.
Polio eradication in progress
• 1988: WHO, UNICEF and Rotary Foundation
• 1994: the Americas were certified as polio-free
• 2000: the Western Pacific Region (including
China) was certified Polio-free
• 2002: Europe was certified as polio-free
SU Dept. of Public Health
The benefit of vaccination III.
Polio eradication in progress
International polio cases per year
Év
Becsült
Regisztrált
1975
-
49,293
1980
400,000
52,552
1985
-
38,637
1988
350,000
35,251
1990
-
23,484
1993
100,000
10,487
1995
-
7,035
2000
-
2,971
2001
-
498
2002
-
1,922
2003
-
784
2004
-
1,258
2005
-
1,998
2006
-
1,985
2009
-
1,604
SU Dept. of Public Health
www.polioeradication.org
The benefit of vaccination IV.
• 1999-2003: Measles deaths
dropped worldwide by
almost 40% (still est.
345,000 deaths)
• 1999-2005: 9 countries of 57
eliminated MNT
• STILL: 1-1.2 million people
die yearly from diseases
preventable by vaccines
(measles, pertussis, tetanus,
Hib)
SU Dept. of Public Health
Global immunization coverage
• Diphteria-pertussis-tetanus
Global coverage of vaccinated infants: 78%
(1985: 20%)
• Polio
Global coverage of vaccinated infants: 78%
(1980: 22%)
• Measles
Global coverage of vaccinated infants: 77%
(1980: 17%)
• Hepatitis B
Global coverage of vaccinated infants: 55%
(1992: 3%)
SU Dept. of Public Health
SU Dept. of Public Health
SU Dept. of Public Health
SU Dept. of Public Health
SU Dept. of Public Health
Measles (Morbilli)
Mumps (Infectious
parotitis)
Rubella
(German measles)
SU Dept. of Public Health
The cost of vaccination
• 2002, Kenya: One week
measles vaccination = 12
million USD saved for ten
years
• US: 1 USD for vaccine = 227 USD saved in healthcare
• Complete immunization of a
child = 20-40 USD
SU Dept. of Public Health
Types of vaccines I.
• Inactivated - these are previously virulent microorganisms that have been killed with chemicals or heat.
Examples: cholera, hepatitis A.
• Live, attenuated - these are live micro-organisms that
have been cultivated under conditions that disable their
virulent properties. Examples: yellow fever, measles,
rubella and mumps.
• Toxoids - these are inactivated toxic compounds from
micro-organisms. Examples: tetanus and diphtheria.
• Subunit - rather than introducing a whole inactivated
or attenuated micro-organism to an immune system, a
fragment of it can create an immune response.
Example: HBV
SU Dept. of Public Health
1. Whole virus vaccines consisting of inactivated viruses.
2. Split virus vaccines consisting of inactivated virus particles
disrupted by detergent treatment.
3. Subunit or surface antigen vaccines consisting essentially of
purified hemagglutinin and neuraminidase from which other
virus components have been removed.
4. Live attenuated (cold-adapted) virus vaccines consisting
of weakened (non-pathogenic) whole virus.
SU Dept. of Public Health
Types of vaccines II.
• Conjugate - certain bacteria have polysaccharide outer coats
that are poorly immunogenic. By linking these outer coats to
proteins (e.g. toxins), the immune system can be led to
recognize the polysaccharide as if it were a protein antigen.
Example: Haemophilus influenzae type B.
• Recombinant vector - by combining the physiology of one
micro-organism and the DNA of the other, immunity can be
created against diseases that have complex infection processes.
Example: HPV
• DNA vaccination - in recent years a new type of vaccine,
created from an infectious agent's DNA called DNA
vaccination, has been developed. It works by insertion (and
expression, triggering immune system recognition) into human
or animal cells, of viral or bacterial DNA. Some cells of the
immune system that recognize the proteins expressed will
mount an attack against these proteins and cells expressing
them.
SU Dept. of Public Health
SU Dept. of Public Health
Vaccines of the
present
future
• Rotavirus – 3-600.000
death / year worldwide
• HPV – cervical cancer
• Pneumococcus – 2
million death / year
• Conjugated
meningococcus
• Malaria
• HIV / AIDS
• S. mutans (caries)
• Cancer
• Nicotine
• Allergy
SU Dept. of Public Health
Classification of immunization
•
•
•
•
•
Active vs. passive
Pre-exposure vs. post-exposure
Parenterally vs. orally vs. intranasally administered
Live (attenuated), inactivated & toxoid/anatoxin
Compulsory vs. recommended
1. Age-related (continuous or campaign-like)
2. Exposure-related
SU Dept. of Public Health
AIMS of immunization/vaccination
• Individual: reducing susceptibility to infectious diseases
• Community: breaking route of infection
herd immunity, community immunity
SU Dept. of Public Health
Immunization coverage, USA 1991-1998
SU Dept. of Public Health
Effective reproduction number
R0 - basic reproduction number - average number of
secondary cases generated by one primary case in a
totally susceptible population
R - effective reproduction number - effective
reproductive rate (R) estimates the average number of
secondary cases per infectious case in a population
made up of both susceptible and non-susceptible hosts
R = R0 x the proportion susceptible
- the basic reproductive rate discounted by the fraction of the
host population that is susceptible
SU Dept. of Public Health
Susceptibility of population
R depends on the level of susceptibility within the population :
-immunity - natural
- arteficial (induced) : vaccination
- induced immunity of population : V - minimal vaccination coverage
VE - vaccine efficacy
not vaccinated
not immunised
despite the vaccination
SU Dept. of Public Health
Vaccine efficacy (VE)
The vaccine efficacy is the rate of the disease in the unvaccinated
minus the rate in the vaccinated divided by the rate in the unvaccinated
measure of how good a vaccine is at preventing disease
- proportion of disease in the vaccinated that can be
prevented by the vaccine
SU Dept. of Public Health
Minimal immunization coverage
If the goal of a vaccination programme is to restrain a disease
spreading (R<1), the vaccine coverage that is required is given by
the following equation:
Therefore we can quantificate the minimal immunization (or
vaccination) coverage that is required to restrain the spread
SU Dept. of Public Health
R0 values and vaccine coverage levels for
particular infectious diseases
•
•
•
•
•
•
•
•
•
Desease
Measles
Pertussis
Diphtheria
Smallpox
Polio
Rubella
Mumps
HIV/AIDS
Mode of Transmission
Airborne
Airborne droplet
Saliva
Social contact
Fecal-oral route
Airborne droplet
Airborne droplet
Sexual contact
Ro min V [%]
12–18 91,7-94,4
12–17 91,7-94,4
6–7 83,3-85,7
5–7 80,0-85,7
5–7 80,0-85,7
5–7 80,0-85,7
4–7 75,0-85,7
2–5 50,0-80,0
(assuming that vaccine efficacy is 100%)
SU Dept. of Public Health
Vaccination coverage in Hungary
2013
2012
2011
2010
2009
2000
1990
1980
BCG
99
99
99
99
99
99
99
99
DTP1
99
99
99
99
99
99
99
99
DTP3
99
99
99
99
99
99
99
99
HepB3
_
_
_
_
_
_
_
_
HepB_BD
_
_
_
_
_
_
_
_
Hib3
99
99
99
99
99
99
_
_
MCV
99
99
99
99
99
99
99
99
MCV2
99
99
99
96
99
99
_
_
PnC3
92
90
84
_
_
_
_
_
Pol3
99
99
99
99
99
99
99
98
_
_
_
_
_
_
_
_
Rota_last
MCV - Measles-containing vaccine
WHO vaccine-preventable diseases: monitoring system
WHO-UNICEF estimates of MCV coverage
SU Dept. of Public Health
Tasks of the vaccinating physician I.
• Examination of the subject
- Any illness in past four weeks - Chronic diseases (immune-suppression)
- Blood transfusion or immunoglobulin received within the past 3 months
- Vaccination history including possible adverse reactions
- Time of last vaccination - Possibility of pregnancy
- Medical history plus physical examination
• Informing the subject
- Purpose
- Risk of adverse reactions
- Information about the immune-status and the time course of vaccination
- Information about the vaccine injury compensation $
- In case of refusal: dangers to self and surroundings, possible sanctions §
SU Dept. of Public Health
Tasks of the vaccinating physician II.
• Vaccine
- Is it the right vaccine? Read brochure before vaccination! - Was it stored properly (e.g. cold chain)?
- Expiry date? (except: influenza vaccines can only be used in a single
influenza season regardless of a later expiry date)
- Does anything about the vaccine’s appearance (cloudy, discolored)
indicate quality loss
•
Documentation
- Informed consent of the vaccinated person or their legal representative
(legal representative in case of children)
- Refusal of vaccination only with written statement by the subject - Refusal cases should be reported to the public health authorities - Registering vaccinations into vaccination booklet/international certification
SU Dept. of Public Health
Most common contraindications of vaccination
• Conditions accompanied by fever • Severe previous complication related to the given vaccine
• Childhood neurological conditions
• Pregnancy (no live vaccines, except vital indication, limited number
of others)
• Hypersensitive / anaphylactic reaction to egg-proteins or
antibiotics (skin test when applicable)
SU Dept. of Public Health
Vaccination of special groups
• Any form of immunosuppression
(generally no BCG & live vaccines)
• Symptomatic AIDS patients, children of HIV-positive mothers
(no BCG, yellow fever, live S. Typhi, MMR individually)
• Splenectomized persons
(diminished reaction to capsular bacteria)
SU Dept. of Public Health
Required intervals between various types of
immunizations
Inactivated /
toxoid
Live viral
BCG
IgG
Inactivated /
toxoid
0
0
0
0
Live viral
0
0/4 weeks
4 weeks
2 weeks
BCG
0
4 weeks
.
0
IgG
0
3 months
0
3 months
Required intervals between certain types of immunization
and blood/blood products ( 6-11 months)
SU Dept. of Public Health
Incorrect reasons for delaying or avoiding a vaccine
You DO NOT have to avoid or delay immunization due to:
• a minor infection without a fever such as a cough or cold
• a family history of adverse reactions following immunizations
• a previous history of diseases such as whooping cough, measles, rubella or mumps infection
• premature birth
• stable neurological conditions such as cerebral palsy
• contact with infectious disease
• asthma, hay fever, eczema or ‘snuffles’
• treatment with antibiotics or locally acting steroids
• the child’s mother is pregnant
• the child is being breastfed
• history of jaundice after birth
• the child is under a certain weight
• the child is over the immunisation age recommended in schedule
• 'replacement' corticosteroids
• a history of allergy
• a personal or family history of inflammatory bowel disease (Crohn’s disease or ulcerative colitis)
• a personal or family history of autistic spectrum disorders
• recent or imminent surgery.
SU Dept. of Public Health
Possible responses to vaccination
• Immunization-related reactions (normal-mild symptoms)
• Immunization-related complications (stronger reaction by
the individual - hypersensitivity)
• Immunization-related accidents (problems with vaccine quality
or administration)
• Immunization related complications and accidents always have
to be reported to the local public health authorities SU Dept. of Public Health
Hungarian schedule of compulsory, age-related
vaccination
Age
0-4 weeks:
2 months:
3 months:
4 months:
15 months:
18 months:
6 years:
11 years:
11 years:
13 or 14 years:
Immunization
BCG
DPaT + IPV + Hib I + PCV13
DPaT + IPV + Hib II
DPaT + IPV + Hib III + PCV13
MMR + PCV13
DPaT + IPV + Hib IV
DPaT + IPV
diphtheria - tetanus (September)
MMR (October)
Hepatitis B
Recommended vaccine: HPV (human papilloma virus vaccine) for girls at age of 12
BCG: Bacille Calmette-Guerin, DPaT: Diphtheria-Pertussis-Tetanus, IPV: Inactivated Polio
Vaccine, MMR: Measles-Mumps-Rubella
SU Dept. of Public Health
SU Dept. of Public Health
SU Dept. of Public Health
Comparison of oral (Sabin) and parenteral (Salk)
Polio vaccines
SALK (IPV, inactivated)
SABIN (OPV, live, attenuated)
Confers humoral immunity
Highly effective
No reactivation of virus
No danger of vaccination poliomyelitis
Suitable in immunosuppression
Confers humoral and mucosal immunity
Highly effective
Virus reactivation theoretically possible
Very rare vaccination poliomyelitis
Not recommended in
immunosuppression
Oral administration
Relatively inexpensive
Parenteral administration
Relatively expensive
WHO recommendation: eradication of both wild type and mutant polioviruses.
From 2010 no OPV will be used worldwide
SU Dept. of Public Health
Compulsory vaccination in case of exposure
Passive immunization
with gamma globulin
Active immunization
(for contacts)
•
•
•
•
•
•
•
•
Abdominal typhoid
Diphtheria
Pertussis
Measles
Rubella
Mumps
Tetanus (exposed patient)
Lyssa/Rabies (exposed patient)
•
•
Hepatitis A contacts (within 14
days of exposure)
Measles contacts (ages 15 months
or younger, or if active
immunization is contraindicated
and within 6 days of exposure)
Mixed (active - passive): tetanus, HbsAg positive mother’s newborn
SU Dept. of Public Health
Source: US National Immunization Program, URL: http://www.cdc.gov/nip
SU Department
SU Dept.ofofPublic
PublicHealth
Health
Source: US National Immunization Program, URL: http://www.cdc.gov/nip
SU Department
SU Dept.ofofPublic
PublicHealth
Health
Tetanus Wound Management
Clean, minor
Wounds
All other
wounds
Vaccination History
Td
TIG
Td
TIG
Unknown or <3 doses
Yes
No
Yes
Yes
No*
No
No**
No***
3+ doses
* Yes, if >10 years since last dose
** Yes, if >5 years since last dose
*** Yes, if >10 years since last dose and serious damage [in Hungary]
Source: Heymann DL. Control of Communicable Diseases Manual, APHA 2004.; National Center for Epidemiology, Methodological
guidence on vaccination, 2007.
SU Dept. of Public Health
Vaccination protocol in case of potential rabies
exposure in Hungary
Animal causing exposure2
Species
Health status
Action to be taken
Healthy, observable for 14 days3
Cat, dog
Fox
Other
No vaccination
Consultation with health
No observation possible
authority, vaccination if
rabies cannot be excluded4
Suspicion of rabies1,3
Vaccination
Assumed to be rabid
Vaccination
Consultation with health authority/ animal health authority
1.
2.
3.
Any animal showing atypical behavior in an endemic area should raise suspicion of rabies.
Exposures include contamination with saliva on skin or mucous membranes, abrasions, scratches, bites.
If the observed animal shows signs of rabies during the observation period, vaccination is to be initiated without
delay. If rabies infection can be excluded in a previously suspicious animal, vaccination should be discontinued.
4.
If the animal becomes observable, vaccination should provisionally be discontinued.
*Vaccination = 5 shots of inactivated Lyssa virus on days 0., 3., 7., 14., 28.
SU Dept. of Public Health
She survived rabies without
vaccination.
A medical marvel - Jeanna Giese
Rabies, a viral disease spread by the bite of an infected
animal, attacks the nervous system and is usually fatal
once symptoms develop. The other five people known to
have survived it after symptoms appeared either were
vaccinated in advance or received vaccine soon
afterward. All but one ended up with persistent
movement difficulties.
SU Dept. of Public Health
She was bitten by a bat she picked up in church.
Vaccinations for occupational infections
• Abdominal typhoid – sewage workers, underground construction
workers, laboratory staff, hospital
infectious ward staff
• Tick-borne encephalitis – forestry workers
• Hepatitis B – health care workers, who regularly come into contact
with blood and various body fluids
• Hepatitis A – health care workers (although hygienic precautions are
usually sufficient to prevent infection)
• Rabies – laboratory staff who work with the Lyssa virus,
veterinarians, flayers, pet shop staff, zoo staff
• Diphtheria – infectious ward staff, laboratory staff, medical students,
booster immunization >10 years
• Tetanus – underground construction workers, agricultural workers,
those involved in animal care,
booster immunization >10 years
• Meningococcus - infectious ward staff, laboratory staff
SU Dept. of Public Health
An oral inactivated cholera vaccine. Large phase three trial
initiated in 1985 showed that the vaccine provided about 85% short term
protection and about 60% protection over three years (protection among
children under five lasted only about one year, suggesting booster doses
may be needed for these children).
SU Dept. of Public Health
Travel-related vaccinations
Compulsory
• Yellow fever vaccine when
traveling to an endemic area
• Meningococcal vaccination
during the Hajj (Saudi Arabia)
• Any vaccine the country of
destination requires
May be recommended
• Cholera
• Diphtheria (former Soviet
Union)
• Hepatitis B, A
• Abdominal typhoid
• Tick-borne encephalitis
• Poliomyelitis
• Others
The WHO annually publishes which vaccines are required in which countries.
Up-to-date information can be obtained at the WHO’s International Travel
Health website at http://www.who.int/ith.
SU Dept. of Public Health
Recommended literature
• The CDC’s Pink Book on Immunization
(http://www.cdc.gov/nip/publications/pink/def_pink_full.htm)
• http://www.who.int
• http://www.cdc.gov
• http://www.immunisation.nhs.uk
SU Dept. of Public Health
Sterilization, disinfection
SUSU
Department
of Public
Health
Dept. of Public
Health
Disinfection vs. sterilization
Disinfection
Sterilization
destroys
Pathogenic microbes
in the external
environment
All microbes
on and within the object
of sterilization
SU Dept. of Public Health
Operation of central sterilization facility
collection of contaminated utensils
cleaning, drying
Disinfection and
cleaning of transport
vehicle
materials storage
packaging
clean, non-sterile
utensils
storage
sterilization
sterile storage
deployment of sterile materials, utensils
(for transportation)
One-way process!
Contaminated → clean principle!
SU Dept. of Public Health
The sterilization process 1.
1. Collection of items:
Dry or wet collection (wet collection in pre-treatment solution)
2. Cleaning:
a) soaking (in blood solvent, disinfectant, detergent, >60oC)
b) mechanical cleaning
c) final rinsing (running warm water), hollow needles 3% H2O2
d) drying
3. Sterilization:
a) packaging, labeling
b) actual sterilization procedure (autoclave, dry heat, plasma,
formaldehyde/ethylene oxide gas)
c) regular quality control
4. Storage
SU Dept. of Public Health
The sterilization process 2. – Important parameters
Hot air
Steam
Gas
Solution
Relative
humidity
Concentration
of active agent
Pressure
Temperature
Exposure time
SU Dept. of Public Health
The sterilization process 3.
Material/utensil
Sterilization method
Heat-resistant items
AUTOCLAVE
Heat-resistant, watersensitive items
Heat-sensitive items
DRY HEAT
Heat-sensitive
endoscopes
Other…
ETHYLENE OXIDE (ETO),
FORMALDEHYDE GAS
PLASMA
Special solution (depends on manufacturer) +
equipment
… i.e. filters
SU Dept. of Public Health
Item collection
SU Dept. of Public Health
Special disinfectant washers
Hospital disinfectant washer 2.
Hospital disinfectant washer 1.
Ultrasound washer
SU Dept. of Public Health
Manual cleaning of utensils
Manual washer with
splash-proof hood
Cleaning gun
SU Dept. of Public Health
Packaging
SU Dept. of Public Health
Autoclaves 1.
SU Dept. of Public Health
Autoclaves 2.
Benchtop cassette autoclaves
SU Dept. of Public Health
Plasma sterilization
Low-temperature (~46°C), low-humidity sterilization with plasma state
hydrogen peroxide created using an electromagnetic field.
Gas-like plasma is actually a cloud of ions, electrons and
neutral atomic particles – the created free radicals and
biologically active particles destroy microorganisms.
After the electromagnetic field is turned off, the hydrogen peroxide
decays to water and oxygen
Used for heat and moisture sensitive materials and utensils, but
various materials may require special conditions (small-bore instruments
may need so called „boosters”).
SU Dept. of Public Health
Low-temperature sterilization of endoscopes
(with solution)
SU Dept. of Public Health
Quality assurance in sterilization and disinfection 1.
ONLY VERIFIED TECHNOLOGICAL SOLUTIONS
THAT CONFORM TO RECOGNIZED QUALITYASSURANCE STANDARDS ARE ACCEPTABLE!
EACH STEP IN THE ENTIRE
STERILIZATION/DISINFECTION PROCESS SHOULD
BE MONITORED INDEPENDENTLY!
SU Dept. of Public Health
Quality assurance in sterilization and disinfection 2.
Checking preparatory procedures (technology, blood-stain
detection)
Checking machinery
1. initial (new machines)
2. continuous (operation log)
3. periodic (technical)
Checking the sterilization process
1. thermo-indicators
2. chemical indicators
3. complex indicators (combination of various parameters)
Checking sterility (microbiological tests)
SU Dept. of Public Health
Quality assurance in sterilization and disinfection 3.
Quality control
procedure
Check equipment
functioning
Control indicator
on package
Frequency
Method
Daily (autoclaves)
Authorities: every 3 years
Steam-penetration test
Every package
Process indicators
Batch control
Every batch
Authorities: every 3-6 months
Chemical/biological indicators
Spore-test
Control indicator
inside package
Every package
Multi-parameter chemical
indicators
Record data
Every package and batch
Sterilization log, labeling… etc.
SU Dept. of Public Health
Package labeling – external indicators
Process indicators
Indicate that the tray, package or packet has been through the process
of sterilization (steam, ETO… etc.), but DO NOT provide information
on the quality of that process; whether necessary parameters were reached
during the process, or whether it was successful or not.
SU Dept. of Public Health
Washer batch indicator
The above indicator has bright-red colored „contamination”. After the batch
of equipment and utensils went through the cleaning / disinfecting
procedure the amount of red material left indicates possible left-over
contamination (blood… etc.).
SU Dept. of Public Health
Quality control of process parameters –
chemical indicators
SU Dept. of Public Health
Steam penetration indicator for autoclaves
National and international standards require
that every autoclave be tested daily with a
process indicator, before routine use. Steam
penetration indicators verify that presterilization vacuum (air removal) and steam
penetration are adequate.
SU Dept. of Public Health
Quality control of process parameters
– complex indicators
Parameters:
• Time
• Temperature
• Steam quality
(penetration)
SU Dept. of Public Health
Quality control for effectiveness of procedure – biological
indicators
SU Dept. of Public Health
Disinfection 1. – Disinfectants by application type
- Hand disinfectants (hygienic, surgical etc…)
-
General skin disinfectants
Mucous membrane disinfectants
Surface disinfectants
Machine/utensil disinfectants
Machine/utensil disinfectants for use in dentistry
Endoscope disinfectants
Incubator disinfectants
Disinfectants for hemodialysis equipment
Body-fluid disinfectants
Disinfecting detergents
Disinfecting soaps
Disinfecting machine/utensil cleaners
SU Dept. of Public Health
Disinfection 2. – Disinfectants by activity spectrum
- Bactericidal
- General
- Special (MRSA,TB…)
- Sporocidal
- Fungicidal
- Virucidal
- Proticidal
- Parasiticidal
SU Dept. of Public Health
Disinfection 3. – Disinfection of the hands
Hygienic and
surgical
disinfection
destroys
Surgical
disinfection
decreases and
covers
Transient flora
Residual flora
SU Dept. of Public Health
Auto-Spout Infra Red Touchless
Activation Water Tap Adapter
Easily operated wrist action quarter turn tap
SU Dept. of Public Health
HyGenius is the complete low-cost hand-washing control
and management program for restaurants, hospitals,
nursing homes, food processing, daycare, biomedical,
laboratory, and cleanroom environments.
The HyGenius system connects to, and takes control of existing hand sinks to
provide step-by-step hand-washing in areas where food safety and infection
control are critical to the public health.
SU Dept. of Public Health
SU Dept. of Public Health
Even microbiological contamination of soap has been shown to
result in infections and nosocomial outbreaks.
SU Dept. of Public Health
SU Dept. of Public Health
Centers for Disease Control
and Prevention (CDC):
Handwashing is the single
most important means
of preventing the spread
of infection.
SU Dept. of Public Health
Disinfection 4. – Disinfection in epidemic control
Disinfection procedures
• Preventive disinfection: general hygiene, disinfectant cleaning
etc…
• Concurrent disinfection: of the surroundings of infectious patients
during period of communicability of disease
• Terminal disinfection: of prior environment of infectious patients
after the end of communicability (convalescence, death)
High-level disinfection usually performed by local public
health authorities!
In Hungary, high-level disinfection required in cases of: anthrax,
cholera, lepra, malleus, plague, typhus exanthematicus
SU Dept. of Public Health
Protective gloves
Should be worn during every procedure, where there is
a potential risk of health care personnel coming into
contact with the patient’s blood, body fluids or where
aseptic conditions are required.
• In the latter case sterile gloves should be worn.
• Removal of gloves should be followed by hygienic hand
disinfection.
• Depending on the circumstances, other protective clothing
(lab coat, water-proof lab coat), safety goggles, face-shield,
mask may be required.
SU Dept. of Public Health
Due to the increasing rate of latex allergy among health
professionals as well as in the general population, the trend has been
towards gloves made of non-latex materials such as vinyl or nitrile
rubber. However, these gloves have not yet replaced latex gloves in
surgical procedures, as gloves made of alternate materials generally do
not fully match the fine control or greater sensitivity to touch available
with latex surgical gloves.
High-grade non-latex gloves (such as nitrile
gloves) also cost two or more times the price of
their latex counterparts, a fact that has often
prevented switching to these alternate materials
in cost-sensitive environments, such as many
hospitals
a blue nitrile medical glove
SU Dept. of Public Health
Advantages of a closed blood specimen collection system
(vacuum tubes)
• no contamination with the patient’s blood
• one-way flow
• less traumatic
• shorter specimen collection time
• adequate sample volume
• precise ratio between sample and additional chemicals (EDTA,
citrate etc…)
• unbreakable plastic tubes
• closed tubes go into centrifuge
• no washing needed (disposable)
• blood/serum does not enter the sewage system
SU Dept. of Public Health
Disinfection 5. – Disinfection in general cleaning
Guiding principles for hospital cleaning is to use wet,
detergent-containing, and disinfectant-containing
cleaning.
Modern hospital cleaning is performed with color-coded
instruments for different parts of the facility (hall, toilets,
rooms…).
Disinfectant agent should be appropriately selected
according to activity spectrum (bactericidal, fungicidal,
virucidal sporocidal…) depending on circumstances.
Information on activity spectrum is displayed on the container of
the disinfectant.
SU Dept. of Public Health
SU Dept. of Public Health
Disposal unit for used
medical "sharps" needles, syringes,
blades and so on.
SU Dept. of Public Health
Medical waste disposal
Medical waste
Treatable as
communal
waste
Confined
storage
Highly
infectious,
potential
epidemic
Special
storage sack
(sustains
134°C)
Blood or bloodclot
contaminated
waste, human
tissues
Special
storage
sack
Hazardous
chemical or
Potentially radioactive
Waste that may
waste
infectious waste
cause injury
Storage in safe
plastic or
cardboard
container
Special
storage
container or
box
Disinfection
Communal
deposition
Communal
incineration
Hazardous waste
incineration
Special
treatment
SU Dept. of Public Health
Disinsection, deratisation
SU Dept. of Public Health
Disinsection
Elimination of arthropods (mosquitos, fleas, lice,
flies, beetles, ticks, moths and other) transmitting
infections
• Physical/mechanical measures
• Chemical measures
• Biological measures
SU Dept. of Public Health
Physical and mechanical measures
• Destroying or removing breeding sites (burning
wastes, draining marshy areas)
• Catching or killing traps (sticky paper)
• Application of mechanical barriers or personal
protective items (bed nets)
• Desinsection of household objects, textiles:
using hot air (moist or dry), steam, boiling, hot
ironing pressing
SU Dept. of Public Health
Insecticide-treated bed nets (ITNs) are a major
intervention for malaria control in endemic regions
SU Dept. of Public Health
Chemical measures
Application of pesticides, insecticides and repellents
• Insecticides are chemicals used to kill insects
• Larvicides are used against insect eggs and larvae
• Insect repellents are applied to skin, clothing, or
other surfaces to ward off insects without killing
SU Dept. of Public Health
Biological measures
• Application of predators of parasites against a
particular arthropod
• Insect growth regulators
• Application of sterilised male anthropods
Mosquitofish (Gambusia affinis)
SU Dept. of Public Health
Deratisation
Eradication of rodents (rats and mice)
• Physical rodent control - traps
• Biological rodent control – natural
predators of rats (cats, rat terriers,
mongooses, etc.)
• Chemical rodent control
SU Dept. of Public Health
Chemical rodent control
Rodenticides (chemical agents aiming to
kill rodents)
coumarin derivates, zinc-phosphidecontaining baits
SU Dept. of Public Health
Ectoparasites: Lice A
Source: CDC Public Health Image Library
SU Dept. of Public Health
Head louse
SU Dept. of Public Health
A magnified view of a female body louse with larvae. Lice
cause itching and a characteristic excoriated skin rash (looks like a scrape).
Only the body louse may transmit relapsing fever, typhus
fever, and trench fever (the head louse and pubic louse do
SU Dept. of Public Health
not!).
SU Dept. of Public Health
Head lice
Eggs (nits)
Head louse (Pediculus
humanus capitis)
• Head lice are apprx. 3mm long, greyish-white and feed on blood from the scalp
• They feed 5-6 times a day, contamination of the puncture site with louse-saliva causes
itching, which is often the first major symptom to arouse suspicion
• Louse eggs, called nits, are small and white and firmly attached to the hair shaft
• Lice and nits are most commonly found on the side and back of the head
• Examination is most efficiently performed with a comb and a magnifying glass
SU Dept. of Public Health
Ectoparasites: Lice B
Body lice
Body
Household
objects
Head lice
Environment
Textiles
Beddings
Outer
garments
Head
Household
objects
Pubic lice
Pubic
area
Premises
Clothes
Areas of treatment
for lice
Underwear
SU Dept. of Public Health
Ectoparasites: Lice C
Method of
treatment
Chemical
(pediculocides)
Physical
(heat)
Area to be treated
Body
surfaces
Textiles
• rubbing in
• washing
• powdering
powdering
• cooking
-
• ironing
• heat-drying
Household
objects
Premises
• powdering
• spraying
• washing
• powdering
• burning
• boiling
-
Agents of chemical anti-lice treatment (in Hungary):
• Hair scrubs: Nittyfor, Pedex
• Other: Nix, 2% Chresyl soap
• Powder: Coopex-B powder
SU Dept. of Public Health
It’s a scabies mite - it burrows into the skin
SU Dept. of Public Health
Scabies rash on hands
SU Dept. of Public Health
Ectoparasites: Scabies (mites)
Source: CDC Public Health Image Library
SU Dept. of Public Health