Hospital Infection Control - Hospital Infection Control and Antibiotics, Study Guides, Projects, Research of Medical Sciences

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Hospital Infection Control and Antibiotics Hospital Infection Control * Nosocomial infections are infections acquired in the hospitals. * Standard precautions used to prevent transmission of diseases due to contact with blood, body fluids, non-intact skin & mucous membranes , contaminated items or possible droplet infections. * These precautions are used when dealing with any individuals (medical staff or patients) whether appear healthy or infectious. * Standard precautions include the followings : I) Hand hygiene : e The most effective precaution to prevent nosocomial infections. e This include washing the hands with soap and water and the use of alcohol gel to decontaminate the hands. e This should be performed before and after contact with the patient, after touching blood ....etc (even when gloves are worn during contact), before eating, after using restroom and after coughing or sneezing. II) Personal protective equipment : e Gloves should be worn when touching blood ....etc. e Surgical masks, gown and goggles are used if there is chance of spray or splash of blood or body fluids. e In the operating room, covering the head with surgical cap. Hospital infection Control & Antibiotics III) Safe handling of needles and sharp instruments to prevent health care workers exposure to blood born infections. e Used needle should be discarded immediately after use and not recapped or removed from the syringe. e Used needles, scalpels or sharp instruments should be placed in sharps plastic waste container. yaa) Authorized Personnel Only Plastic medical sharp container (waste box) III) Safe injection practice :(to prevent hepatitis B, hepatitis C & HIV infections ) e Use a new needle and syringe with each injection of a patient and every time a medical vial or IV bag is accessed. Medical vial IV bag Hospital infection Control & Antibiotics 1) Heat: The standard method for sterilization is autoclaving (steam at 134 °C , under 2 atmospheric pressure for 20- 30 minutes ) . Autoclave 2) Chemical sterilization : + It used if heat is not suitable for sterilization. « Glutaraldehyde (Cidex) at long immersion time e.g. immersion of endoscopes and laparoscopes control bacteria and hepatitis virus and HIV. The instruments should be washed with sterile saline after its use as glutaraldehyde is toxic . 3) Irradiation : as gamma or ultraviolet rays for industrial sterilization of catheters or syringes . 4) Gas sterilization : « Ethylene oxide gas for wrapped equipments. « Gas plasma for delicate catheters and endovascular wires. Hospital infection Control & Antibiotics Antibiotics * Choice of suitable antibiotic :depends on the following factors: 1)Initial diagnosis and the initial antibiotic chosen should be effective against the possible causative organism. 2)Relevant samples e.g. pus, urine or sputum, should be obtained for culture and sensitivity before the first dose of antibiotic is given. 3)The change from one antibiotic to another should be based mainly on the clinical response and result of culture & sensitivity. If there is satisfactory clinical response we don’t change antibiotic. 4)The dose and duration of antibiotic course depend on the pathology, clinical and laboratory assessment. Unnecessary high dose or prolonged course of antibiotic should be avoided whenever possible to avoid its toxicity. 5)Toxic or costly antibiotic should be avoided if an equally effective substitute exists. 6)Patient factors: allergy to antibiotic, renal & hepatic functions, tolerance to oral drugs, age, immunity and if female whether pregnancy or lactating. * Important points related to antibiotic therapy in surgical practice : 1) Antibiotic prophylaxis is administration of antibiotic before surgical procedure (preoperative antibiotic). Hospital infection Control & Antibiotics e The best timing is 30-120 minutes before the incision. e If surgical procedure is prolonged, another dose of antibiotic is added during the operation (intra-operative). e Usually it needs not to exceed the operation period. It is extended only for one day after the operation (perioperative antibiotic prophylaxis) if there is gross contamination as colonic or rectal surgery. e This achieves high tissue level of antibiotic to prevent bacteria from getting foothold when contamination occurs. e Surgical site infections including post-operative wound infections are markedly decreased by antibiotic prophylaxis. e The first line of treatment of post-operative wound infection : « Early before pus formation is antibiotics. « After pus formation: drainage of pus by partial removal of sutures . 2) Cefazolin (first generation cephalosporin ) is the best prophylaxis in gastroduodenal surgery , cardiothoracic surgery , orthopaedic surgery and neurosurgery . e In penicillin allergic patient fluroquinolone (e.g. ciprofloxacin ) is the antibiotic of choice . 3) Combination of Cefazolin and metronidazole ( for anaerobic bacteria ) is the best prophylaxis in colo-rectal surgery . e In penicillin allergic patient fluroquinolone (e.g. ciprofloxacin ) with metonidazole or clindamycin is the combination of choice . 4) Normal colonic bacteria residence are mixture of Gram negative bacilli and anaerobes.