Infections in Healthcare
and Medical Asepsis
Toronto hospital’s persistent
bacterial infection outbreak
blamed on ‘state-of-the-art’ sinks
Helen Branswell, Canadian Press | Jul 25, 2012 8:07 AM ET
An investigation aimed at pinpointing the
source of a lingering bacterial outbreak in a
Toronto hospital turned up an unlikely suspect.
The sinks did it.
State-of-the-art handwashing sinks installed in
the intensive care unit and some patient rooms in
Toronto’s Mount Sinai Hospital actually became
the reservoir of a pesky drug-resistant bug that
infected or colonized 66 patients from the fall of
2006 to the spring of 2011.
The outbreak involved Klebsiella oxytoca, a
bacterium that normally lives in the human
gut. It typically causes urinary tract infections,
but can also trigger bacteremia — infection in
the blood.
Dr. Allison McGeer, Mount Sinai’s
head of infection control and senior
author of the study, says hospitals
know that as a rule these bacteria
spread from a patient who is
carrying them to other patients.
Find the colonized patient — a
person carrying Klebsiella oxytoca
(KO) but not sickened by them —
and make sure he or she is treated
in isolation, and you can prevent
transmission.
That’s the way it’s supposed to work.
And using anal swabs, the hospital staff did
locate people carrying the bacteria. But
despite taking the appropriate measures, the
bug continued to spread.
When ICU patients became infected even
though there were no KO carriers in the ICU,
it became clear there had to be a non-human
source. Then began a process of elimination.
In the Mount Sinai outbreak, McGeer’s team
believes sinks became contaminated when
staff used them to dispose of body fluids. Not
urine, she says, but perhaps fluid from chest
tubes or half-used IV bags.
“There’s a lot of fluid that needs to be
disposed of from ICU patients from a whole
variety of sources,” she says.
McGeer says in the end some relatively simple changes to the
mechanics of the sinks seem to have solved the problem. Drains are
now covered by screens with smaller holes, to minimize the potential for
back splash. The overflow drains were blocked and traps were moved
further back from the basin.
Infections in Healthcare Settings
• Nosocomial infection:
infection acquired after
admission to a health care
facility
- microbes can enter
body through equipment
used in treatments,
therapies and tests
(equipment must be free
of pathogens)
Factors that increase the risk of infection:
•
•
•
•
•
•
•
Young and old are at risk
Poor nutrition
Lack of sleep
The presence of disease or illness
Certain medication
Invasive procedures
Open wounds
Most common infections
• Respiratory tract infections (cold,
pneumonia, bronchitis, influenza)
• Urinary tract infections (UTIs)
• Gastrointestinal infections (nausea or
diarrhea)
• Skin infections (wound or IV site
infection)
Modes of Transmission
• Contact : physical touch (direct or indirect)
• Droplet: microbes are spread short distances (less
than 1 meter) in the air by droplets – coughing,
sneezing and talking
• Airborne: microbes are transmitted long distances
(greater than 1 meter) by air currents
• Vehicle: microbes are transmitted by a
contaminated source (vehicle) – ex. food, water,
medication and invasive medical equipment.
• Vector-borne : insects or pests transmit microbes
to humans
Preventing infections in healthcare
settings:
• Medical asepsis
• Isolation precautions
• Surgical asepsis
Medical Asepsis
• State of being free of pathogens (asceptic
techniques reduce the number of microbes)
• Prevents the spread of microbes from one
person/place to another person/place
• Breaks the chain of infection
Asceptic Practices
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•
•
•
•
Hand Washing
Sanitizing
Disinfection
Sterilization
Controlling reservoirs, portals of exit/entry,
transmission, and protect the susceptible host
• Wearing your PPEs (gloves, masks, protective
apparel, eye protection, face shield)
• Proper disposal and bagging of PPEs
Occupational Safety and Health Act
• Federal regulations related to infection control and
asepsis were developed by the Department of
Labor’s Occupational Safety and Health
Administration (OSHA)
• These laws protect health-care workers from health
hazards on the job, particularly from accidentally
acquiring infections and health hazards patients and
any other people who may come into the medical
office
The following must be discarded in a
biohazardous waste container
•
•
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•
blood products
body fluids
human tissues
Vaccines
table paper, linens, towels, and gauze with body fluids on
them
• Used scalpels, needles, sutures with needles attached, and
other sharp instruments
• Used gloves, disposable instruments, cotton swabs, and
disposable applicators
OSHA laws ensure
• That proper measures are taken to prevent
infection
• Provide a margin of safety,
• Ensure that a medical facility meets at least
the minimal criteria for asepsis
• These laws include: requirements for training
personnel, keeping records, housekeeping,
wearing protective gear
OSHA divides tasks into 3 categories
• Category I – tasks that expose a worker to
blood, body fluids, or tissues or those that
have a chance of spills or splashes. *These
tasks always require specific protective
measures
• Category II – minimal risk of exposure ex.
administering nose drops (hand washing)
• Category III – tasks that do not require any
special protection (ex. talking to the patient)
Standard vs Universal Precautions
• Standard Precautions are used in hospitals
• Universal Precautions are used in medical
offices
What is WHMIS ?
The Workplace Hazardous Materials
Information System (WHMIS) is
Canada's hazard communication
standard.
What are the main parts of WHMIS?
The main components of WHMIS are:
hazard identification and product classification
labeling
material safety data sheets, and
worker training and education
Why was WHMIS created?
It was created in response to the
Canadian workers' right to know about
the safety and health hazards that may
be associated with the materials or
chemicals they use at work.
The 6 WHMIS classes:
1.
Compressed gas
2.
Flammable and Combustible
material
3.
Oxidizing material
4.
Poisonous and Infectious
materials
– Materials Causing Immediate and
Serious Toxic Effects
– Materials Causing Other Toxic Effects
– Biohazardous Infectious Material
5.
Corrosive material
6.
Dangerously Reactive
material