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0:00
[Music] Hello and welcome to Unit 2 of Infectious Disease 101. In this second unit of the module, we'll be looking at Infection Prevention and Control (IPC)
0:21
Infections can be associated with the devices used in medical procedures, such as catheters and ventilators. These HAIs include central line-ssociated bloodstream infections, catheter-associated urinary tract infections, and ventilator-associated pneumonia. Surgical site infections can also occur. An effective IPC program as a healthcare facility is essential for preventing and reducing HAIs and antibiotic resistance, and in preparing for, managing, and preventing infectious disease outbreaks.
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We learnt in the previous unit that, for an infection to spread, all steps in the 'chain of transmission' must occur and that the key to stopping the spread of infection is to break at least one link in that chain. In the healthcare setting, the chain of infection refers to the numerous opportunities for pathogens to spread among patients, healthcare providers and other members of staff, and the environment. Effective IPC aims to break the chain.
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Understanding the chain of infection enables us develop IPC measures that break the chain. Here, we have a pictorial representation of the chain of transmission. We have the infectious agent going through the 'reservoir'. From the 'reservoir', leaving through the 'portal of exit', and then via the 'mode of transmission', using the 'portal of entry' into the 'susceptible host'. So, we look at what the 'portal of exit' is. Organisms must exit their reservoir to spread. For example,
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when someone coughs, microorganisms leave the person through the respiratory tract. Portals of exit can include breaks in skin, mucous membranes, hands, blood, and the gastrointestinal and urinary tracts. Portals of exit can also be splashes from vomiting, or an exposed needle in an open sharps container. We look at the 'portal of entry'. Intravenous catheters and other devices, and surgical incisions can provide entry ways for microorganisms to gain access to a susceptible host.
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Mucous membranes are an entryway for microorganisms spread by direct contact, sprays and splashes. When healthcare personnel wear masks or face shields, this prevents microorganisms from coming in contact with the eyes, nose, or mouth. Breaks in the skin, such as a puncture caused by a 'sharps' injury can also be an entry way. Notice that portals of entry can also serve as portals of exit for harmful microorganisms. The susceptible host is the final link in the chain of transmission.
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When patients receive medical treatment, the following factors can increase susceptibility to infection. Number one is the underlying medical condition such as diabetes, cancer, and organ transplantation which increase risk for infection due to decrease in immunity. We also have certain medications such as antibiotics, steroids and some chemotherapy medications which increase the risk of some types of infections. Thirdly are medical devices and procedures,
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such as urinary catheters, tubes and surgery, which increase the risk of infection by providing additional ways for microorganisms to enter the body. Now we'll look at Standard and Transmission-based Precautions. The role of IPC is to break the chain of transmission. Standard and transmission-based precautions are core IPC practices that healthcare personnel use to reduce transmission of microorganisms in all healthcare settings. Standard precautions aim to protect both
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healthcare providers and patients from infectious agents. They are required in all healthcare settings. Standard precautions are recommended for care for all patients in any healthcare setting regardless of their suspected or confirmed diagnosis. Standard precautions include hand hygiene, environmental cleaning, injection and medication safety, risk assessment with appropriate use of personal protective equipment, reprocessing of reusable medical equipment,
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waste management, respiratory hygiene and cough etiquette. Transition-based precautions are used, in addition to standard precautions, for patients who are suspected or confirmed to be infected or colonized with certain pathogens for which the mode of transmission is known. Transmission-based precautions include contact precautions, droplet precautions, and airborne precautions. The type of precaution assigned to a patient will depend on
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the mode of transmission of the suspected or confirmed pathogen. It is important to recognize risk in the healthcare setting. Risk recognition is a skill that every individual working in healthcare should be able to perform for both themselves and their patients: identifying sources of infection or actions that can lead to infection. It relies on an understanding of why IPC is implemented, and not just memorization of what is needed.
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Risk recognition is a broad approach to IPC that includes both direct patient care and consideration of the surrounding environment. All healthcare personnel should constantly assess risk related to their activities. Real-time awareness enables immediate action to reduce or eliminate risk. A more formal assessment can be performed to assess and reduce risk related to environmental surfaces, new devices or procedures,
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or factors related to physical layout and furnishings in the patient care area. Here, we have a table of the of questions to consider and actions to take. For example, we have Decision One: the healthcare provider can ask, 'do I need protection for what I am about to do because there is risk of exposure to blood and body fluids or mucus?' And then the action to take is: 'I must follow standard precautions because there is a risk
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that I might expose myself to an infection that is transmitted via this route or expose the patient to my microorganisms'. Decision two: 'Do I need protection for what I am about to do because the patient has diagnosed symptoms of infection?' and the action will be: 'I must alert someone about the patient showing symptoms so that a diagnosis can be made and I must determine what precautions to perform to protect others and myself'. Now we look at the 'Hierarchy of Controls'.
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When 'risk' has been recognized, do you know how to control it? The 'hierarchy of controls' helps healthcare personnel determine the most reliable controls to reduce the risk from hazards during health care delivery. The image shown here represents this hierarchy. The most reliable methods do not rely on human behavior or memory. The best control is 'elimination' or 'substitution' of a hazard. When elimination or substitution are not possible,
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'engineering controls' can reduce potential exposure to hazards. 'Administrative controls' and 'use of personal protective equipment' at the bottom of the hierarchy require healthcare provider to take specific actions to reduce the risk - they do not control the hazard itself. Now we look at elimination and substitution. This entails removing the hazard of substituting it with something that is less risky. These methods are the most effective at reducing hazards.
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However, they tend to be the most difficult to implement. This is especially true if the risk is associated with an existing process. Examples of elimination is using a suitable alternative instead of an injection, and substitution could entail using blunt-tip suture needles instead of sharp-tip needles. Engineering controls! These are control measures designed to isolate healthcare personnel from hazards. Examples include preventing sharps injury by using safety-engineered syringes,
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needle shields, and sharps containers that prevent emptying. We could also have using ventilation systems, (for example, negative pressure rooms: pulling air from the hallway to the patient's room and venting directly outside) that prevent airborne pathogens from leaving isolation rooms and exposing others in the hallway. 'Administrative controls' reduce risk by providing protocols and procedures for tasks. This type of control relies on people adhering to administrative rules.
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Examples include implementing contact precautions. For example, use of a single room, and of gloves and gowns stops the spread of potential pathogens. Also, a facility's written IPC plans inform healthcare providers of protocols. Education and training requirements for healthcare providers also enforces protocols. We could have screening assessments, rapidly identifying infectious disease risk. 'Personal protective equipment' such as gloves, gowns,
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surgical masks, respirators and other specialized clothing play an important role in IPC but require consistent and correct use. Use of personal protective equipment is the least reliable control method because it does not control the hazard itself but relies on human decision-making and performance meaning that there is a potential for human error always. An effective IPC program is a systematic defined way to prevent HAIs and antibiotic resistance
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and prepare for, manage, and prevent infectious disease outbreaks. An IPC program is a horizontal program which means that it affects every aspect of patient care and is applicable in all patient care settings from wound treatment to complex invasive surgery. Note that a vertical program, like one for tuberculosis, deals with only a single disease. IPC Professionals at Healthcare Facilities. Ideally, an IPC professional leads and oversees
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the development, implementation, coordination and evaluation of IPC program in a healthcare facility. The number of IPC professionals per facility depends on the acuity and complexity of the patient population. Acuity, used here to refer to nursing care workload, is the complexity of care required for an individual patient or group of patients. Greater acuity (or severity of illness) and complexity will require more dedicated IPC staff. For facilities with limited or no IPC staffing,
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you could consider using a step-wise approach to implement IPC activities. As a starting point, a nurse or a doctor or other healthcare provider might spend one to two days per week on IPC activities. Nurses on wards can be assigned to help expand the reach of IPC throughout the facility, that is, link nurses or IPC Champions. This approach can help build an IPC team while also increasing IPC awareness throughout the facility. What are the core components of an effective IPC?
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In the year 2016, the World Health Organization released guidelines defining the elements of an effective IPC. Known as the 'Core Components of IPC', they serve as a roadmap for how IPC can prevent harm caused by HAIs and antimicrobial resistance. These components should be implemented together - all of them are required to build an effective IPC strategy. The core components include an IPC program; IPC guidelines; IPC education and training; HAI surveillance; multi-modal strategies;
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monitoring and audit of IPC practices, and feedback; workload, staffing, and bed occupancy; built environment, materials, and equipment for IPC at the facility level. "Implementation" is another way to refer to the day-to-day activities of IPC. Implementation is a process, not an event, and does not happen overnight. There are many ways to implement an IPC program. Each method depends on a strategy - a plan worked out in advance - to be effective.
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This can look different from one facility to another, depending on national, regional or facility-level considerations. Implementing IPC also requires the support of key stakeholders and partner organizations. Each IPC professional or team works collaboratively to determine the best way to implement IPC. At a minimum, the IPC program must clearly define roles and responsibilities, demonstrate administrative support, outline oversight and accountability, and ensure resources are provided.
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A World Health Organization implementation manual and a range of tools and resources have been developed for IPC staff in healthcare facilities. A multi-modal strategy entails implementation of IPC policies and practices which are more likely to be successful using more than one method. Let us look at an example of how to use a multi-modal strategy in IPC. Imagine that you are an IPC focal person and you notice that a significant number of injections in the medical ward
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are not being administered safely. Your first course of action might be to assess barriers to performing safe injections. Based on this, there might be a need to train relevant staff on how to give safe injections. Training is an administrative tool in the hierarchy of controls but it is only one activity or strategy that will influence implementation of this new practice. So, once training is complete, you decide to routinely observe staff, making sure to provide feedback.
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Then, you could post job aids about safe injection practices in areas of the clinic where staff give injections. And then, purchasing safety engineered syringes that reduce personal injury and prevent needle recapping could be the last strategy. So, we see that we have implemented at least four strategies in this challenge. So these four activities combined - training, observation and feedback, posters/visual reminders, and purchasing safety-engineered syringes -
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constitute a multi-modal strategy and give you a greater chance of successful implementation.
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