Improving Patient Safety

Through Infection Control

September 15, 2022

REGINA STARLA A. DIZON, RN

Acting Infection Prevention and Control Officer
 OBJECTIVES:
 Recognize patient safety as an important nursing responsibility.
 Identify the most effective and least expensive way for providers to prevent the spread of
infection.
 Apply required knowledge in preventing and/ or minimizing infections.
 Perform appropriate behaviors required to prevent HAIs and provide patient with safe care.
 DEFINTION OF TERMS:
 PATIENT SAFETY – defined by the WHO as a health care discipline that emerged with the
evolving complexity in health care systems and the resulting rise of patient harm in health care
facilities. It aims to prevent and reduce risks, errors and harm that occur to patients during
provision of health care.
 DEFINTION OF TERMS:
 SAFETY CULTURE – defined by the JCI as the product of individual and group beliefs,
values, attitudes, perceptions, competencies, and patterns of behavior that determine the
organization’s commitment to quality and patient safety.
 DEFINTION OF TERMS:
 INFECTION CONTROL – refers to the policy and procedures implemented to control and
minimize the dissemination of infections in hospitals and other healthcare settings with the main
purpose of reducing infection rates.
 PATIENT SAFETY SITUATIONS CAUSING MOST
CONCERNS:
 Medication errors are a leading cause of injury and avoidable harm in health care systems:
globally, the cost associated with medication errors has been estimated at US$ 42 billion
annually.
 Health care-associated infections occur in 7 and 10 out of every 100 hospitalized patients in
high-income countries and low- and middle-income countries respectively.
 Unsafe surgical care procedures cause complications in up to 25% of patients. Almost 7
million surgical patients suffer significant complications annually, 1 million of whom die during
or immediately following surgery.
 PATIENT SAFETY SITUATIONS CAUSING MOST
CONCERNS:
 Unsafe injections practices in health care settings can transmit infections, including HIV and
hepatitis B and C, and pose direct danger to patients and health care workers; they account for a
burden of harm estimated at 9.2 million years of life lost to disability and death worldwide
(known as Disability Adjusted Life Years (DALYs).
 Diagnostic errors occur in about 5% of adults in outpatient care settings, more than half of
which have the potential to cause severe harm. Most people will suffer a diagnostic error in
their lifetime.
 Unsafe transfusion practices expose patients to the risk of adverse transfusion reactions and
the transmission of infections. Data on adverse transfusion reactions from a group of 21
countries show an average incidence of 8.7 serious reactions per 100 000 distributed blood
components.
 PATIENT SAFETY SITUATIONS CAUSING MOST
CONCERNS:
 Radiation errors involve overexposure to radiation and cases of wrong-patient and wrong-site
identification. A review of 30 years of published data on safety in radiotherapy estimates that
the overall incidence of errors is around 15 per 10 000 treatment courses.
 Sepsis is frequently not diagnosed early enough to save a patient’s life. Because these infections
are often resistant to antibiotics, they can rapidly lead to deteriorating clinical conditions,
affecting an estimated 31 million people worldwide and causing over 5 million deaths per year.
 Venous thromboembolism (blood clots) is one of the most common and preventable causes of
patient harm, contributing to one third of the complications attributed to hospitalization.
Annually, there are an estimated 3.9 million cases in high-income countries and 6 million cases
in low- and middle-income countries.
 GOAL:
 Prevent and/or minimize the adverse events and eliminate preventable harm in health care.

 All health care professionals including nurses are responsible for ensuring patient safety.
 PREVENTING INFECTION:
 Requires healthcare providers who have:
 Knowledge of common infections and their vectors

 An attitude of cooperation and commitment

 Skills necessary to provide safe care

 Required Knowledge
 Knowledge of the extent of the problem

 Knowlegde of the main causes, mode of transmission, and types of infections

 Required Attitude
 Being an effective team player

 Commitment to preventing HAI’s

 Required Skills
 Apply Universal Precautions

 Use personal protection methods

 Know what to do when exposed

 Encourage others to use standard precaution

 Report break in technique that increases patients risks

 Observe patient for signs and symptoms of infections

 MODE OF TRANSMISSION:
 Direct or Contact transmission is through direct transfer from one person to another. This can
be through biting, touching, kissing, or sexual intercourse.
 Indirect transmission can be either vehicle or vector-borne.
 A vehicle is anything that serves as a way to transfer a microorganism from the host to the susceptible
person.
 Vector-borne transmission is when an animal or insect transports the infectious agent.
 Airborne transmission can include droplets or dust. Evaporated droplets and dust particles
containing the infectious agent can remain in the air for long periods.
 SUSCEPTIBLE HOST:
 Risk factors include:
 age (very young and very old)
 immune suppression treatment for cancer or organ transplant
 immune deficiency conditions
 chronic disorders
 disorders that require immunosuppressive therapy
 HEALTHCARE ASSOCIATED INFECTIONS:
 Healthcare-associated infections (HAIs) also known as nosocomial infections, are infections
acquired following admission to a healthcare facility that weren't present before admission.
They are infections that you get while receiving treatment at a healthcare facility, like a hospital,
or from a healthcare professional, like a doctor or nurse.
 HEALTHCARE ASSOCIATED INFECTIONS:
 Central Line/ Peripheral Line Associated Bloodstream Infection (CLABSI/ PLABSI) is a
bloodstream infection when germs enter your bloodstream through a catheter or medical tube inserted
into your vein.
 Catheter Associated Urinary Tract Infections (CAUTI) happen as a result of having a urinary
catheter when you are in a healthcare facility or while receiving healthcare at home.
 Ventilator-associated Pneumonia (VAP) can occur when you are on a ventilator, a machine that helps
you breathe through a tube in your mouth, nose or throat. Germs can get into your lungs through the
tubes and make you sick.
 Surgical site infection (SSI) is an infection that occurs after surgery in the part of the body where the
surgery took place. They can be simple skin infections, or they can get into the deeper tissues and
organs near your wound.
 Clostridium difficile Infections (CDIs), also referred to as C-diff, can give you diarrhea that lasts for a
long time. Older people who take antibiotics and use medical services are most at risk for CDIs.
 HEALTHCARE ASSOCIATED INFECTIONS:
 IMPACT OF HAI’S:
 Increase patient’s suffering
 Lead to permanent disability
 Lead to death
 Prolong hospital stay
 Increase need for a higher level of care
 Increase the cost to patient’s and hospital
 BASIC PRINCIPLES OF INFECTION CONTROL:
 Standard precautions are guidelines that were established to break the chain of infection and
reduce the risk of pathogen transmission in hospitals. Standard precautions apply to blood and
body fluids, secretions and excretions (except sweat), nonintact skin, and mucous membranes.
 Following standard precautions not only protects patients, but also healthcare workers.
 Used for all patient care.
 BASIC PRINCIPLES OF INFECTION CONTROL:
 Transmission-Based Precautions are the second tier of basic infection control and are to be
used in addition to Standard Precautions for patients who may be infected or colonized with
certain infectious agents for which additional precautions are needed to prevent infection
transmission.
 BASIC PRINCIPLES OF INFECTION CONTROL:
 Patient and family education are critical aspects of providing care to patients and their
families.

 Nursing practice includes evaluating and reporting a patient's response to treatment. Removal
of certain devices such as urinary catheters, central lines, and peripheral I.V. lines when the
patient no longer needs them is important to returning patients to their optimum level of health
and avoiding HAIs. Routine rounding to evaluate the patient's need for such devices is your
responsibility.
 BASIC PRINCIPLES OF INFECTION CONTROL:
 A bundle approach to the prevention of HAIs, such as ventilator-associated pneumonia (VAP)
and central line-associated bloodstream infection (CLABSI), has been proposed. The use of
bundles has been shown to effectively reduce infections. By implementing all elements of the
bundle, improvements in patient outcomes can be attained.
 BASIC PRINCIPLES OF INFECTION CONTROL:
 Communicable diseases can be transmitted to patients who are under the care of healthcare
workers who report for work when they're ill. You have the responsibility to look after your
own health to avoid compromising patient safety.
 Fit for duty includes meeting basic physical requirements for safely performing essential
functions of the job without compromising patient safety. This means that staff members are
free of active symptoms such as fever, cough, sore throat, and gastrointestinal illness.
 STANDARD PRECAUTION:
 Hand hygiene is the most effective way to prevent transmission of infection. Healthcare
workers' hands are the most common vehicle for the transmission of healthcare-associated
pathogens from patient to patient and within the healthcare environment.
 Hand hygiene is the number one weapon in preventing the spread of microorganisms and
includes alcohol-based hand rubs and hand washing with soap and water.
 Keeping fingernails one-fourth of an inch or less in length and avoiding the use of artificial
nails, nail extenders, and nail decorations is necessary to ensure hand hygiene products reach
hand surfaces and cuticles.
STANDARD PRECAUTION:
 PPE includes gloves, gowns, masks, respirators, and eyewear that create barriers to protect
skin, clothing, mucous membranes, and the respiratory tract from infectious organisms.
STANDARD PRECAUTION:
 To promote injection safety, gloves should be worn when administering injections. Puncture-
proof disposal systems are recommended to dispose of uncapped needles and sharps. Never
recap needles following administration of medication to reduce your risk of being stuck with an
unclean needle.
 Use of needless tubings/ devices
 Do not overload the bin, if it is full
 STANDARD PRECAUTION:
 Environmental cleaning includes medical equipment and environmental surfaces. Any
reusable equipment, including stethoscopes, bandage scissors, and hemostats, that's used on
multiple patients must be cleaned between each patient contact, following organizational policy,
with a broad-spectrum antimicrobial agent. Nursing staff should work closely with
environmental services to ensure that rooms are thoroughly cleaned and disinfected between
patients to prevent the spread of infection through inanimate objects.
 STANDARD PRECAUTION:
 Respiratory hygiene and cough etiquette are infection control measures that should be
implemented when contact is made with a patient who might have an upper respiratory
infection. Patients with signs and symptoms of a respiratory infection should be taught to cover
their mouth and nose with a tissue when coughing or sneezing and dispose of the tissue in the
nearest trash container as soon as possible.
 STANDARD PRECAUTION:
 Nurses and other healthcare workers often use medical devices on more than one patient. You're
responsible for cleaning and disinfecting the device between each patient use.
 TRANSMISSION-BASED PRECAUTION:
 Contact precaution: Used in addition to standard precautions when caring for patients with
known or suspected diseases that are spread by direct or indirect contact.
 For those patients, standard precautions are needed, plus limit transport and movement of
patients, use disposable patient care equipment, and thorough cleaning and disinfection
strategies.
 TRANSMISSION-BASED PRECAUTION:
 Droplet precautions: Used for patients with known or suspected infections that can transmit by
air droplets through the mechanism of a cough, sneeze, or by talking.
 In such cases, it is vital to control the source by placing a mask on the patient, use standard
precautions plus limitation on transport and movement.
 Droplet precautions require the use of a surgical mask in addition to standard precautions when
you're within 3 ft of a patient known to have or suspected of having a disease spread by
droplets.
 TRANSMISSION-BASED PRECAUTION:
 Airborne precautions: Use for patients with known or suspected infections that can be
transmitted by the airborne route. Those patients require to be in an airborne infection isolation
room with all the previously mentioned protections.
 Airborne precautions are used in addition to standard precautions when in contact with patients
with known or suspected diseases spread by fine particles transmitted by air currents. You must
wear a National Institute for Occupational Safety and Health certified, fit-tested N-95 respirator
just before entry into an area shared with a patient suspected or known to have one of these
diseases.
 BUNDLE OF CARE:
 A care bundle is a set of interventions that, when used together, significantly improve patient
outcomes. Multidisciplinary teams work to deliver the best possible care supported by
evidence-based research and practices, with the ultimate outcome of improving patient care. A
care bundle is a set of three to five evidence-based practices—interventions supported by
research—that when used together cause significant improvement in patient outcomes.
 The care bundle is an ongoing process that's repeated daily until the patient no longer requires
an invasive device or his or her status has improved. The steps of the care bundle are carefully
selected, well-established practices that are packaged together and scientifically supported.
 BUNDLE OF CARE:
 Ventilator-associated Pneumonia (VAP)
 DVT Prophylaxis
 GI Prophylaxis
 Head of Bed Elevated to 30-45 degrees
 Daily Sedation Vacation
 Daily Spontaneous Breathing Trial
 BUNDLE OF CARE:
 Central Line/ Peripheral Line Associated Bloodstream Infection (CLABSI/ PLABSI)
 Hand Hygiene
 Maximal Barrier Precautions Upon Insertion
 Chlorhexidine Skin Asepsis
 Optimal Catheter Site Selection, with Avoidance of the Femoral Vein for Central Venous Access in
Adult Patients
 Daily Review of Line Necessity with Prompt Removal of Unnecessary Lines
 Decontamination of the Catheter Hub Before Each Access
 Change of Dressing Every 7days and as Needed
 BUNDLE OF CARE:
 Catheter Associated Urinary Tract Infections (CAUTI)
 Hand Hygiene
 Daily Meatal Hygiene and After Every Bowel Movement
 Drainage Bag Kept Lower than the Patient’s Bladder at All Times
 Urinary Drainage Bag Emptied Regularly into a Clean Container
 BUNDLE OF CARE:
 Surgical Site Infection (SSI)
 Using of Clippers in Removing Hair
 Chlorhexidine Bath
 Antibiotic Prophylaxis
 Adequate Oxygenation
 Monitoring of Patient’s Body Temperature
 Monitoring of Patient’s Blood Sugar
 BARRIERS TO COMPLIANCE:
 Emergency situations
 Non-availability of equipment
 Patient discomfort
 Lack of time and nursing personnel
 Providing care to children
 Psychological factors
 Experienced nurses
 Physicians influence
 SUMMARY:
 In summary, infection prevention and control programs are a critical and longstanding
component of broader efforts to ensure the safety of patients in the health care system. The field
of infection prevention serves as a prime example of how transparency and patient advocacy,
coupled with national surveillance systems and federal investments, can lead to important gains
in our efforts to eliminate emerging and existing infectious threats to patients in health care
facilities.
 As nurses, we have the ability to impact the lives of our patients in many ways. Patients trust us
to make decisions that will keep them safe from harm, including infection. We have the power
to change the culture of noncompliance and reduce the number of HAIs.
 Avoiding shortcuts can minimize the potential for disease transmission.
 REFERENCES:
 https://www.who.int/news-room/fact-sheets/detail/patient-safety
 https://www.jointcommissioninternational.org/standards/international-patient-safety-goals/
 https://journals.lww.com/nursingmadeincrediblyeasy/fulltext/2015/05000/
basic_principles_of_infection_control.7.aspx#:~:text=These%20include%20standard%20precautions%20(hand,%2C
%20droplet%2C%20and%20airborne).
 https://journals.lww.com/nursingmadeincrediblyeasy/Fulltext/2011/05000/Your_role_in_infection_prevention.9.aspx
 https://journals.lww.com/nursingmadeincrediblyeasy/fulltext/2011/03000/
understanding_care_bundles.9.aspx#:~:text=A%20care%20bundle%20is%20a,outcome%20of%20improving
%20patient%20care.
 https://www.ncbi.nlm.nih.gov/books/NBK519017/
 https://psnet.ahrq.gov/perspective/how-does-infection-prevention-fit-safety-program
 https://health.ri.gov/diseases/healthcareacquiredinfections/#:~:text=Healthcare-Acquired%20Infections
%20(%20HAIs%20),like%20a%20doctor%20or%20nurse.
THANK YOU! ☺