Infection Control and Patient Safety Dr. NAHLA ABDEL KADERوMD, PhD. INFECTION CONTROL CONSULTANT, MOH INFECTION CONTROL CBAHI SURVEYOR Infection Control Director, KKH.

1. 1

2. What is Patient Safety?
In its simplest form,
patient safety is
“prevention of harm to
patients.”
٢

3. Infection Control
• Infection control (IC) is a quality
standard that is essential for the well
being and safety of patients.
• It affects most departments of the
hospital and involves issues of quality,
risk management, clinical governance
and health and safety.
٣

4. ٤

5. International Patient Safety
Goals
Identification
Communication Medication Eliminate Infection
Falls
٥

6. Identification
Identify Patients Correctly

Use at least two (2) ways to
identify a patient
٦

7. IPSG.1
Identify Patients Correctly


A collaborative process is used to develop policies and/or
procedures that address the accuracy of patient identification
Use at least two (2) ways to identify a patient:
•
•
•
•
•

giving medications
giving blood and blood products
taking blood samples
taking other samples for clinical testing
providing treatment or procedure
The patient’s Room Number cannot be used as an identifier
٧

8. Verification Process
Correct Patient (Identification)
Scope: All radiology procedures
 Ask the patient
“What is your FULL NAME?”
“What is the name of the PROCEDURE you are having
today?”. Also ask SITE/SIDE if required
 Never state patient’s Name
“Do not tell the patient… the patient tells you”
E.g. Call “Mr. Abdullah”, then ask the above questions
including additional questions related to clinical history as
outlined on Request Form
٨

9. Correct Patient (Identification)
Cont.
 Inpatients
1. Ask patient to state Full Name/ Procedure
2. Check responses against Referral Form & Patient ID Band
(wrist/ankle) including MRN– MANDATORY
Do Not Proceed if :

Patient ID Band is absent. Call Ward Nurse to personally ID
patient and complete Time Out Verification sticker (all
personnel sign).

Patient can not verbalise identity. Nurse Escort must verify
patient identity. Complete Time Out Verification sticker (all
personnel sign).
٩

10. Verification Process - Cont.
 Outpatients
1.Ask patient to state Full Name/ Procedure
2.Check responses against Referral Form
Do Not Proceed if :
 Patient can not verbalise identity.
Proceed only after :
 Identity is verified by accompanying relative, family
member, friend or healthcare interpreter.
١٠

11. Reinforcing the Message
Displayed at all
imaging consoles
Have you checked the
Patient ID ?
- Prior to the Procedure Asked patient their:
• Name
• (Procedure)
Are you
sure !
Checked response &
MRN against ID Band &
Request Form
١١

12. Communication
Improve Effective Communication

Implement a process/procedure
for taking verbal or telephone
orders
١٢

13. IPSG 2: Improve Effective
Communication

A collaborative process is used to develop policies and/or
procedures that address the accuracy of verbal and telephone
communications
 Person receiving the following:
• Verbal order
• Telephone order
• Reporting of critical test results
Must use a verification “read back” of complete order or test
result
 The order or test result is confirmed by the individual who gave
the order or test result
١٣

14. Critical Test Results

Ensure that there is collaborative
process to determine what they
are

Clinical Laboratories





Bedside testing
Imaging Studies
Electrocardiogram
Pulmonary Function Testing
other
١٤

15. “Do Not Use” list:





u
IU
qd
qod
Leading decimal point
(always use a Leading
zero)

Trailing zero
١٥

16. Medication Safety
Improve the Safety of High-alert
Medications
Remove concentrated electrolytes
from patient care units
١٦

17. IPSG 3: Improve Safety of High Alert
Medications


A collaborative process is used to develop policies and/or
procedures that address the location, labeling and
storage of concentrated electrolytes
Concentrated electrolytes are not present in patient care
units unless clinically necessary and actions are taken to
prevent inadvertent administration in those areas where
permitted by policy
Remove concentrated electrolytes from
patient care units
١٧

18. Eliminate
Eliminate Wrong-site, Wrongpatient, Wrong-procedure
Surgery
 Use a checklist, including a “timeout,” before surgery
 Verify that documents and equipment
are correct and functioning properly
before surgery
 Mark precise site where surgery will
be performed
١٨
١٨

19. IPSG 4: Ensure Correct-site, Correctprocedure, Correct-patient Surgery

Collaborative process used to develop P&P

Mark the precise site in clearly understood way
and involve patient in doing this

Develop process or checklist to verify correct
documents and functioning equipment

Use a Checklist including “Time-Out” just before
surgical procedure
١٩

20. Team Time Out –
Interventional (invasive) Radiology
(All invasive procedures covering CT / Ultrasound / Angiography / Mammography
and selective Screening procedures)
In procedure room, with patient present.
Confirm patient ID, request/consent forms, image data all correct.
Site marked by interventional doctor.
Team Leader calls Time Out immediately prior to procedure
commencement (patient draped) to confirm:
 Verification of patient identity (Full Name/MRN/ID Band)
 Agreement on the intended procedure
 Verification of correct position i.e level & side
 Verification of the visible marked site
 Availability of correct implants/equipment/medication
– DO NOT proceed until resolve discrepancies (document)
٢٠

21. Universal Protocol
DOCUMENTS
SURGERY
SITE
EQUIPMENT
PATIENT
BODY PART
PROCEDURE
٢١

22. Infections
Reduce the Risk of Health Careacquired Infections
A collaborative process is used to develop P&P
that address reducing the risk of health
care–associated infections


Comply with current published and
distributed hand hygiene guidelines
IPSG 5: Reduce the Risk of Health
Care-Associated Infections.
٢٢

23. 
Contact Precautions

Airborne Precautions

Droplet Precautions
٢٣

24. Falls
Reduce the Risk of Patient Harm
Resulting from Falls
 Assess and periodically reassess
each patient’s risk for falling
٢٤

25. FALLS
 Falls
are a common cause of
morbidity and the leading cause of
nonfatal injuries and traumarelated hospitalizations.
 Falls occur in all types of healthcare
institutions and to all patient
populations.
 In hospitals, falls consistently make
up the largest single category of
reported incidents.
٢٥

26. IPSG 6: Reduce the Risk of Patient
Harm resulting from Falls
 Develop P&P using collaborative process
 Assess and periodically Reassess each
patient’s risk for falling, including the
potential risk associated with the patient’s
medication regime,
 Take action to decrease or eliminate any
identified risks.
A fall can be prevented by thoughtful strategies designed for
the individual patient (e.g., a low bed).
٢٦

27. Improving Patient Safety
means . . .
Reducing Medical Errors
Reducing HAIs
٢٧

28. WHO Patient Safety



WHO Patient Safety was launched in October
2004
with the mandate to reduce the adverse health
and social consequences of unsafe health care
An essential element of WHO Patient Safety is
the formulation of a Global Patient Safety
Challenge:
a topic that covers a significant aspect of risk
to patients receiving health care, relevant to
every WHO Member State
The First Global Patient Safety Challenge was
launched in 2005
٢٨

29. Through the promotion of best
practices in hand hygiene, the
First Global Patient Safety
Challenge aims
to reduce health care-associated
infection (HCAI) worldwide
٢٩

30. HCAI rates reported
from developing countries
Type of survey
Prevalence
Incidence
(%)
(%)
Incidence
(per 1000
patient-days)
Hospital-wide
4.6–19.1
2.5–5.1
9.7–41.0
Adult ICU
18.4–77.2
4.1–38.9
18.2–90.0
Neonatal ICU
2.9–57.7
2.6–62.0
SSI
Incidence
(per 1000
device-days)
1.2–38.7
VAP
2.9–23.0
CR*-BSI
1.7–44.6
CR*-UTI
3.2–51.0
WHO Guidelines on Hand Hygiene in Health Care (2009)
٣٠

31. Device-associated infection rates in ICUs in
developing countries compared with NHSN rates
Surveillance network,
study period, country
Setting
N°
patients
CLA-BSI*
VAP*
CR-UTI*
INICC, 2002–2007,
18 developing countries†1
PICU
1,808
6.9
7.8
4.0
NHSN, 2006–2007, USA2
PICU
/
2.9
2.1
5.0
INICC, 2002–2007,
18 developing countries†1
Adult
ICU #
26,155
8.9
20.0
6.6
NHSN, 2006–2007, USA2
Adult
ICU#
/
1.5
2.3
3.1
* Overall (pooled mean) infection rates/1000 device-days
INICC = International Nosocomial Infection Control Consortium; NHSN = National Healthcare Safety
Network; PICU = paediatric intensive care unit; CLA-BSI = central line-associated bloodstream infection; VAP
= ventilator-associated pneumonia; CR-UTI = catheter-related urinary tract infection.
Rosenthal V et al. Am J Infect Control 20081
rgentina, Brazil, Chile, Colombia, Costa Rica, Cuba, El Salvador,
NHSN report. Am J Infect Control 2008† 2
Nigeria, Peru, Philippines, Turkey, Uruguay
India, Kosova, Lebanon, Macedonia, Mexico, Morocco,
Medical/surgical ICUs #
٣١

32. Most frequent sites of infection
and their risk factors
URINARY TRACT INFECTIONS
Urinary catheter
Urinary invasive procedures
34%
13%
Advanced age
Severe underlying disease
Urolitiasis
Pregnancy
Diabetes
Most common
sites LACK OF
of health careassociated infection
HAND
and the risk factors
SURGICAL SITE INFECTIONS
underlying the
HYGIENE
Inadequate antibiotic prophylaxis
occurrence of
Incorrect surgical skin preparation
infections
Inappropriate wound care
Surgical intervention duration
Type of wound
Poor surgical asepsis
Diabetes
Nutritional state
Immunodeficiency
Lack of training and supervision
LOWER RESPIRATORY TRACT INFECTIONS
Mechanical ventilation
Aspiration
Nasogastric tube
Central nervous system depressants
Antibiotics and anti-acids
Prolonged health-care facilities stay
Malnutrition
Advanced age
Surgery
Immunodeficiency
BLOOD INFECTIONS
Vascular catheter
Neonatal age
Critical care
Severe underlying disease
Neutropenia
Immunodeficiency
New invasive technologies
Lack of training and supervision
17%
14%
٣٢

33. HOSPITAL ENVIRONMENT
HIV
TB
٣٣

34. How are infections transmitted?
٣٤

35. How to Break the
Chain of Infection????
٣٥

36. Hand hygiene is the simplest, most
effective measure for preventing
Healthcare -Associated Infections.
٣٦

37. ٣٧

38. ٣٨

39. 30%-40% of all HAIs are Attributed to Cross
Transmission:
٣٩

40. ٤٠

41. What is the KKH Multimodal Hand
Hygiene Improvement Strategy?
ONE System change

Based on the
evidence and
recommendati
ons from the
WHO
Guidelines on
Hand Hygiene
in Health Care
(2010), a
number of
components
make up an
effective
multimodal
strategy for
hand hygiene
Access to a safe, continuous water supply as well as
to soap and towels; readily accessible alcohol-based handrub
at the point of care
TWO Training / Education
Providing regular training to all health-care workers
THREE Evaluation and feedback
Monitoring hand hygiene practices, infrastructure, perceptions
and knowledge, while providing results feedback to healthcare workers
FOUR Reminders in the workplace
Prompting and reminding health-care workers
FIVE Institutional safety climate
Creating an environment and the perceptions that facilitate
awareness-raising about patient safety issues
٤١

42. So Why All the Fuss About Hand
Hygiene?
Most common mode of transmission
of pathogens is via hands!
 Infections acquired in
healthcare
 Spread of antimicrobial
resistance
٤٢

43. All health care’s works involve the
hands
٤٣

44. Hands are contaminated
Hands
spread
germs
٤٤

45. The health care environment is
contaminated
٤٥

46. The inanimate environment is a
reservoir of pathogens
X represents a positive Enterococcus culture
The pathogens are ubiquitous
~ Contaminated surfaces increase cross-transmission ~
Abstract: The Risk of Hand and Glove Contamination after Contact with a VRE (+)
Patient Environment. Hayden M, ICAAC, 2007, Chicago, IL.
٤٦

47. The inanimate environment is a
reservoir of pathogens
Recovery of MRSA , VRE & ACINITOBACTER.
Devine et al. Journal of Hospital Infection. 2007;43;72-75
Lemmen et al Journal of Hospital Infection. 2004; 56:191-197
Trick et al. Arch Phy Med Rehabil Vol 83, July 2006
Walther et al. Biol Review, 2007:849-869
٤٧

48. The Iceberg Effect
Infected
Colonized
٤٨

49. Colonized or Infected:
What is the Difference?

People who carry bacteria without
evidence of infection (fever,
increased white blood cell count)
are colonized

If an infection develops, it is
usually from bacteria that colonize
patients

Bacteria that colonize patients can
be transmitted from one patient to
another by the hands of healthcare
workers
٤٩

50. Patients are vulnerable to
infection
٥٠

51. ٥١

52. Types of Hand Hygiene
 Normal
hand washing
 Antiseptic hand washing
 Alcohol-based hand rub
Can be used instead of hand
washing , if hands are not
visibly soiled with blood or
any other patient body fluids
 Surgical hand wash
٥٢

53. Routine Hand Washing
٥٣

54. Antiseptic Hand Washing
٥٤

55. Waterless Hand Rub
“alcohol-based hand rub
٥٥

56. Efficacy of Hand Hygiene Preparations
in Killing Bacteria
Good
Plain soap
Better
Antimicrobial
soap
Best
Alcohol-based
hand rub
Guideline for Hand Hygiene in Health-Care Settings MMWR,2010. vol. 51, no. RR-16.
٥٦

57. Hand Hygiene Options
Wet hands, apply
soap and rub for
>10 seconds.
Rinse, dry & turn
off faucet with
paper towel.
Apply to palm; rub
hands until dry
~ Use soap and water for visibly soiled hands ~
~ Do not wash off alcohol handrub ~
٥٧

58. Surgical Hand Wash
٥٨

59. ٥٩

60. ٦٠

61. Areas Most Frequently Missed
HAHS © 1999
٦١

62. Hand Hygiene
Compliance
Hand Hygiene
Comment
Typical
Compliance
Observational studies of hand hygiene
report compliance rates of 5-81%
Common
Reported
Barriers To
Compliance
Insufficient time, understaffing, patient
overcrowding, lack of knowledge of hand
hygiene guidelines, skepticism about hand
washing efficacy, inconvenient location of
sinks and hand disinfectants and lack of
hand hygiene promotion by the institution
٦٢

63. With hand hygiene they’re dead
٦٣

64.  Skin
irritation
 Inaccessible hand washing
facilities
 Wearing gloves
 Too busy
 Lack of appropriate staff
 Being a physician
(“Improving Compliance with Hand Hygiene in Hospitals” Didier
Pittet. Infection Control and Hospital Epidemiology. Vol. 21 No. 6
Page 381)
٦٤

65. Why Not?
 Working
in high-risk areas
 Lack of hand hygiene
promotion
 Lack of role model
 Lack of institutional priority
 Lack of sanction of noncompliers
٦٥

66. Successful Promotion 




Education
Routine observation & feedback
Engineering controls
 Location of hand basins
 Possible, easy & convenient
 Alcohol-based hand rubs
available
Patient education
(Improving Compliance with Hand Hygiene in Hospitals. Didier Pittet.
Infection Control and Hospital Epidemiology. Vol. 21 No. 6 Page 381)
٦٦

67. Successful Promotion 
 Reminders
in the workplace
 Promote and facilitate skin care
 Avoid understaffing and
excessive workload; Nursing
shortages have caused
٦٧

68. Clean Care is Safer Care
The First Global Patient Safety Challenge
SAVE LIVES: Clean Your Hands
5 May 2009–2020
Through an annual day focused on
hand hygiene improvement in
health care, this initiative
promotes continual, sustainable
best practice in hand hygiene at
the point of care in all health-care
settings around the world
٦٨

69. ٦٩

70. Hand Care
 Nails
 Rings
 Hand
creams
 Cuts & abrasions
 “Chapping”
 Skin Problems
٧٠

71. Fingernails & Artificial Nails

Keep fingernails short


Allows thorough cleaning and prevents
glove tears
Long nails make glove placement more
difficult and may result in glove
perforation
٧١

72. Fingernails & Artificial Nails

Follow MCH policy regarding artificial
fingernails; use of artificial
fingernails is not allowed.
USAF Guidelines for Infection Control in Dentistry, 2004.
٧٢

73. What is the Story on Moisturizers
and Lotions?
ONLY USE facility-approved and supplied lotions
Because:
 Some lotions may make medicated
soaps less effective
 Some lotions cause breakdown of latex
gloves
 Lotions can become contaminated with
bacteria if dispensers are refilled
~ Do not refill lotion bottles ~
٧٣

74. Gloves are not substitute for
Gloves are not a a substitute for
handwashing!
handwashing!
≠
٧٤

75. Wearing gloves does not replace the
need for hand hygiene

Small, inapparent
defects

Frequently torn during
use

Hands frequently
become contaminated
during removal
DeGroot-Kosolcharoen 2004, Korniewicz 1999, Kotilainen 2001, Olsen 1998, Larson 2005,
Murray 2001, Burke 2005, Burke 1990, Nikawa 1994, Nikawa 2006, Otis 2007
٧٥

76. What is the single most important reason
for healthcare workers to practice good
hand hygiene?
1. To remove visible soiling from hands
2. To prevent transfer of bacteria from
the home to the hospital
3. To prevent transfer of bacteria from
the hospital to the home
4. To prevent infections that patients
acquire in the hospital
٧٦

77. How often do you clean your hands
after touching a PATIENT’S INTACT
SKIN (for example, when measuring
a pulse or blood pressure)?
pressure)?
1.
Always
2.
Often
3.
Sometimes
4.
Never
٧٧

78. Estimate how often YOU clean your
hands after touching a patient or a
contaminated surface in the hospital?
1.
25%
2.
50%
3.
75%
4.
90%
5.
100%
٧٨

79. Which hand hygiene method
is best at killing bacteria?
1. Plain soap and water
2. Antimicrobial soap and
water
3. Alcohol-based hand rub
٧٩

80. Which of the following hand hygiene
agents is LEAST drying to your skin?
1. Plain soap and water
2. Antimicrobial soap and
water
3. Alcohol-based hand rub
٨٠

81. It is acceptable for healthcare workers to supply
their own lotions to relieve dryness of hands in
the hospital.
1. Strongly agree
2. Agree
3. Don’t know
4. Disagree
5. Strongly disagree
٨١

82. Healthcare-associated organisms are
commonly resistant to alcohol.
1. Strongly agree
2. Agree
3. Don’t know
4. Disagree
5. Strongly disagree
٨٢

83. When a healthcare worker touches a patient who is
COLONIZED, but not infected with resistant
organisms (e.g., MRSA or VRE) the HCW’s hands
are a source for spreading resistant organisms to
other patients.
1. Strongly agree
2. Agree
3. Don’t know
4. Disagree
5. Strongly disagree
٨٣

84. A co-worker who examines a patient with VRE,
then borrows my pen without cleaning his/her
hands is likely to contaminate my pen with VRE.
1. Strongly agree
2. Agree
3. Don’t know
4. Disagree
5. Strongly disagree
٨٤

85. How often do you clean your hands after touching an
ENVIRONMENTAL SURFACE near a patient (for
example, a countertop or bedrail)?
1. Always
2. Often
3. Sometimes
4. Never
٨٥

86. Use of artificial nails by healthcare
workers poses no risk to patients.
1. Strongly agree
2. Agree
3. Don’t know
4. Disagree
5. Strongly disagree
٨٦

87. ٨٧

88. Glove use for all patient care contacts is a
useful strategy for reducing risk of
transmission of organisms.
3. Don’t know
4. Disagree
5. Strongly
disagree
٨٨

89. ٨٩

90. ٩٠

91. Infection Control is
Everyone’s Responsibility!
٩١

92. Each Healthcare Provider is like a piece of a jigsaw
puzzle: each piece needs to fit together to form a best
Infection Control Practices!
Respiratory
Therapists
Physicians
Paramedics
Nurses
Patient/
Family
Administrative
Staff
Pharmacists
Patient Care
Assistant
Non Clinical
Staff
Dieticians
Phlebotomists
٩٢

93. Teamwork and Effective Communication
For Patient Safety
٩٣

94. ٩٤

95. HAND HYGIENE AWARENACE
٩٥