New Strategies Infection Prevention Control (IPC)

Dr.dr.Hindra Irawan Satari, SpA(K), M.Trop PaedChief, Infection Control Committee RSCM

Chief, Indonesia Society of Infection Control, Jakarta BranchChief, Infectious Diseases and Tropical Pediatrics Division, Ciptomangunkusumo Hospital-FKUI, Jakarta

CONTENTS Goal

Program

Measureable elements

Conclusion

What is the goal of an IPC organization’s

to identify and to reduce the risks of acquiring and transmitting infections among patients, staff, health care professionals, contract workers, volunteers, students, visitors.

Who are the leader the PCI program ? Leaders

Qualified in infection prevention and control practices through education, training, experience, or certification.

Well-trained staff IPCN IPCN-link

How to have an effective programs and how ?

Methods to identify and to proactively address infection risks,

Appropriate policies and procedures, Program is based on current scientific knowledge, accepted practice guidelines,

applicable laws and regulations, and standards for sanitation and cleanliness.

Staff education

Coordination through-out the organization. Coordination mechanism that involves physicians, nurses, and others.

The management provide adequate resources to support the infection prevention and control program.

RSCM : Pelatihan PPI rutin 4 kali/thn untuk petugas kesehatan lama (inservice

training)

Orientasi PPI bagi karyawan baru di RSCM 2 kali setahun

METODE PERENCANAAN PDSA

A

ACTTentukan perubahan apa yang diinginkan

PLANPerubahan atau uji

STUDYSimpulkan dari apa yang dapat dipelajari

DOPelaksanaan kegiatan

SIKLUS PDSA

Tindakan yang dilakukan / perubahan

Pengumpulan data audit lokal

Analisis data audit dan umpan balik pada tenaga medis

Who are involves in the PCI program coordination ? Physicians, including ICU, ICCU, PICU, NICU Nurses IPC professionals Laboratory

Clinical Microbiologist, Clinical Pathologist Housekeeping and laundry Unit Central Supply Sterile Installation Food production Unit Engineering Installation Pharmacy Department Pharmacology Department Sanitation and environment Unit Others, based on the size and complexity of the organization.

Direktur Utama

Komite PPIRS

Dep/Unit/Instalasi/Bidang

Anggota

IPCO/IPCN – Link Dep/Unit/Instalasi/Ruangan

Sekretaris

IPCN

SK Dirut No : 8978/TU.K/34/V/201

1

Struktur organisasi

What the PCI program based on ? Current scientific knowledge. Accepted practice guidelines. Applicable laws and regulations. Standards from national or local

agencies for sanitation and cleanliness.

What the PCI program focus of ?

All patient, staff, and visitor areas of the organization are included in the infection prevention and control program.

Risk-based approach identifies the procedures and processes associated with the risk of infection and implements strategies to reduce infection risk.

What is an comprehensive PCI program ? Systematic and proactive surveillance activities

(Endemic) Rates of infection.

Systems to investigate outbreaks of infectious diseases.

Guided by appropriate policies and procedures.

Risk-reduction goals and measurable objectives.

Regularly reviewed.

DOCUMENTS Policy

Standard Operational Procedure

Working Instruction

What are areas of the PCI Program included ? All patient care areas

All staff areas

All visitor areas

What is the measuring elements in Surveillance Program of PCI ?

a) Respiratory tract Associated with intubation, mechanical ventilatory support, tracheostomy, and so on

b) Urinary tract Associated with indwelling urinary catheters, urinary drainage systems, and so on

c) Intravascular invasive devices The insertion and care of central venous catheters, peripheral venous lines, and so on

d) Surgical sites Dressing and associated aseptic procedures

e) Epidemiologically significant diseases and organisms Multi drug resistant organisms, highly virulent infections

f) Emerging or reemerging infections with the community

INSIDEN RATE IAD RSCM, JANUARI-JUNI 2012 SERTA TINDAK LANJUT

1 2 3 4 5 60.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

1.67 1.641.99

0.860.40

0.91

Insiden rateBaik (<3.5‰)Kurang(>6.16‰)

JML H

ARI P

EMAS

ANGA

N C

VL/1

000

EDUKASI PPIPREPARASI KULIT DENGAN CHORHEXIDINE –ALKOHOL 2% : KERINGKEBERSIHAN TANGANRONDE 3x /mgg& SUPERVISI

INSIDEN RATE IAD RSCM, JANUARI-JUNI 2012 SERTA TINDAK LANJUT

BUKU PETA BAKTERI DAN KEPEKAAN TERHADAP ANTIBIOTIK

Linezo

lid

Vancomycin

Teicoplanin

Imipen

em

Meropen

em

Amikacin

Tigecy

cline

Levofloxa

cin

Colistin

Gentamicin

Fosfo

mycin

Gatifloxacin

Neomyci

n

Ciprofloxacin

Nitrofurantoin

Cefepim

e

Piperacill

in/Tazobacta

m

Cefpiro

me

Ceftazid

ime

Tetracyc

line

Oxacill

in

Ampicillin

/Sulbacta

m

Chloramphenico

l

Trimeth

oprim/Su

lfameth

oxazole

Kanamycin

Erythromyci

n

Amoxicillin

/Clavulanic a

cid

Cefopera

zone

Aztreo

nam

Nalidixic

acid

Ceftria

xone

Cefotaxim

e

Pipemidic a

cid

Cephalothin

Ampicillin

Penicil

lin G

0

10

20

30

40

50

60

70

80

90

100

GAMBARAN SENSITIF (%S) TERHADAP ANTIBIOTIKRSCM Juli-Desember 2010

Unit Farmasi dan Terapi

PPRATim PPRA +Pokja PPRA

Pedoman

antibiotik

Pola

Bakter

i

Data AntibiotikData

Surveillans

SISTIM PENGENDALIAN RESISTENSI ANTI MIKROBA

Tim Farmakologi KlinikKomite PPIRS

Tim Lab/Mikrobiologi

DIREKTURLaporan

ANTIBIOTIC GUIDANCE PATHWAY

PPAB Team

Dept/UPT/InstTeam

Workgroup PPRA Dept/Inst/UPT

Clinical Microbiology Team

Medical CommitteeCq Pharmacy Therapy Unit

PPRA Team DirectorGuidance ab

Draft

TANPA AB

1 MACAM

2 MACAM

3 MACAM

> 3 MACAM

05000

1000015000200002500030000350004000045000 41359

19292

81972510 2120

PENGGUNAAN ANTIBIOTIK DI RSUPN DR CIPTO MANGUNKUSUMO TAHUN

2011

JUM

LAH

What is the measurable elements in the Surveillance Program?

The data collected in a) through f) are evaluated / analyzed.

Based on data evaluation/analysis, actions are taken to focus or to refocus the organization’s infection prevention and control program.

Assesses these risks at least annually.

The assessment is documented.

CSSD and management of laundry and linen in PCI programs

Ensuring adequate equipment cleaning and sterilization and the proper management of laundry and linen.

There is a policy and procedure in place that identifies the process for managing expired supplies and defines the conditions for reuse of single- use devices when laws and regulations permit.

Proper disposal of waste.

Policy and procedure on the disposal of sharps and needles should available.

Reduces the risk of infections in the facility associated with operations of the food service and of mechanical and engineering controls.

Reduces the risk of infection in the facility during demolition, construction, and renovation.

MANAJEMEN LINEN DAN LAUNDRI

What are the measurable elements in theCSSD, Laundry and linen management

Equipment cleaning, disinfection and sterilization methods in a central sterilization service and outside (satellites) are appropriate for the type of equipment.

Laundry and linen management are appropriate to minimize risk to staff and patients.

There is a coordinated oversight process that ensures all cleaning, disinfection, and sterilization methods are the same throughout the organization.

How to manage the expired supplies and single-use reused devices in CSSD ?

There is a policy and procedure consistent with national laws and regulations and professional standards in place that identifies the process for managing expired supplies.

When single-use devices and materials are reused, the policy includes items a) through e) in the intent statement.

The policy is implemented.

The policy is monitored.

What is the measurable elements in infectious waste and body fluids, mortuary and postmortem area management ?

Disposal of infectious waste and body fluids are managed to minimize transmission risk.

The handling and disposal of blood and blood components are managed to minimize transmission risk

Operation of the mortuary and postmortem area are managed to minimize transmission risk.

What is the measurable elements in theDisposal of sharps and needles management

Collected in dedicated, puncture-proof containers that are not reused.

The hospital disposes of sharps and needles safely or contracts with sources that ensure the sharps containers are disposed of in dedicated hazardous waste sites or as determined by national laws and regulations.

Consistent with infection prevention and control policies of the organization.

WASTE MANAGEMENT

Waste typeSOLID:

InfectiousNon infectious

LIQUIDInfectiousNon infectious

SHARP DEVICES

WASTE MANAGEMENT

SOLID: Infectious and non

infectiousSHARP DEVICES

What are the Measurable Elements ofKitchen Sanitation and Food Preparation and handling

management Kitchen sanitation and food preparation and handling are appropriate to

minimize infection risk. Eg. Personal Protective Device

Engineering controls are implemented to minimize infection risk in appropriate areas of the organization. Eg.Ventilation

What is the measurable elements to asses the impact of renovation or new construction Uses risk criteria (Infection Control

Risk Assessment / ICRA)

Including on air quality

Assessed

Managed.

What is the measurable elements in the Isolation Precaution Program

Patients with known or suspected contagious diseases are isolated

Policies and procedures address Separation of patients with communicable diseases from patients and staff who are at greater risk due to

immunosuppression or other reasons. Manage patients with airborne infections for short periods of time when negative pressure rooms are not

available.

Strategy of dealing with an influx of patients with contagious diseases.

Negative pressure rooms are available and monitored routinely for infectious patients who require isolation for airborne infections; when negative pressure rooms are not immediately available, rooms with approved HEPA filtration systems may be used.

Staff are educated in the management of infectious patients.

KEWASPADAAN ISOLASI

KEWASPADAAN STANDARKEWASPADAAN BERDASAR

TRANSMISI

1. Hand hygiene

2. Personal protective device (PPD)

3. Sharp devices and waste management

4. Isolation procedure

5. Environment control

6. Linen management/laundry

7. Disinfection and sterilization

8. Health care worker safety

9. Lumbal puncture procedure

10. Cough etiquette

11. Safety injection

BERBASIS KONTAK:

MRSA DROPPLET:

Pneumonia UDARA:

TBC

What is the measurable elements in thePersonal Protective Equipment and Hand hygiene program ?

Identifies those situations for which gloves and/or masks or eye protection are required.

Gloves and/or masks or eye protection are correctly used

The organization identifies those situations for which hand washing and hand disinfection or surface disinfecting procedures are required.

Handwashing and hand disinfection procedures are used correctly in those areas. The organization has adopted hand-hygiene guidelines from an authoritative source.

KEPATUHAN PETUGAS MELAKUKAN KEBERSIHAN TANGAN RSCM JANUARI - JUNI 2012

1 2 3 4 5 60%

10%20%30%40%50%60%70%80%90%

82%66% 68% 69% 76% 78%

% KepatuhanTarget(> 85%)Kurang(<75%)

What is the information management systems role in PCI program ?

Information management systems support the infection prevention and control program.

Measurable Elements Personal Protective Equipment and Hand Hygiene

The organization identifies those situations for which gloves and/or masks or eye protection are required.

Gloves and/or masks or eye protection are correctly used in those situations.

Handwashing and hand disinfection procedures are used correctly in those areas. The organization has adopted hand-hygiene guidelines from an authoritative source.

The 5 moments for Hand Hygiene

The organization identifies those situations for which hand washing and hand disinfection or surface disinfecting procedures are required.

Measurable ElementsIntegration of the Program with Quality Improvement and Patient Safety

Health care–associated infection risks are tracked. Infection prevention and control activities are measured.

The measures identify epidemiologically important infections. Processes are redesigned based on risk, rate, and trend data and information.

Processes are redesigned to reduce infection risk to the lowest levels possible. Health care–associated infection rates are compared to other organizations’ rates through comparative databases. Compares its rates to best practices and scientific evidence. Measurement results are communicated to medical staff, nursing staff and to management. Infection prevention and control program results are reported to public health agencies as required.

Takes appropriate action on reports from relevant public health agencies.

What are the measurable elements in the Education Program of PCI ?

Education about infection prevention and control to All staff and other professionals.

All staff are educated on the policies, procedures, and practices of the infection prevention and control program.

Periodic staff education is provided in response to significant trends in infection data.

Patients and families.

CONCLUSIONGoal PCI : to identify and to reduce the risks of acquiring and

transmitting infections among patients, staff, health care professionals, contract workers, volunteers, and visitors

Standards: Leadership and organization, program and coordination

Focus of the Program Isolation Procedures, including Barrier Technique and Hand Hygiene Integration with Quality Improvement and Patient Safety

THANK YOU