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Paediatric Infection Control Jodie Burr Infection Control Coordinator Women’s and Children’s Hospital.

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Presentation on theme: "Paediatric Infection Control Jodie Burr Infection Control Coordinator Women’s and Children’s Hospital."— Presentation transcript:

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2 Paediatric Infection Control Jodie Burr Infection Control Coordinator Women’s and Children’s Hospital

3 Primary Role of Infection Control Prevent nosocomial infections Prevent nosocomial infections Reduce mortality, morbidity, and cost Reduce mortality, morbidity, and cost Educate and advise Educate and advise staff staff patients patients their families their families the community the community Surveillance of nosocomial infections Surveillance of nosocomial infections Policy development, implementation and assessment Policy development, implementation and assessment

4 IC Issues specific to Paediatrics Communicable diseases affect a higher % of paediatric patients than adults Communicable diseases affect a higher % of paediatric patients than adults Developmental immunity (increased susceptibility) - acquire – spread Developmental immunity (increased susceptibility) - acquire – spread

5 IC Issues specific to Paediatrics Paediatric personnel are at a greater risk for exposure to communicable diseases - immune status Paediatric personnel are at a greater risk for exposure to communicable diseases - immune status Type and amount of physical contact (eg feeding, diapering) Type and amount of physical contact (eg feeding, diapering)

6 IC Issues specific to Paediatrics May lack the mental / physical ability to adhere to IC principles May lack the mental / physical ability to adhere to IC principles lack of hygiene lack of hygiene unable to understand / comply with IC principles unable to understand / comply with IC principles

7 IC Issues specific to Paediatrics More likely to have contact with contaminated environmental surfaces and objects More likely to have contact with contaminated environmental surfaces and objects

8 IC Issues specific to Paediatrics Parents and siblings Parents and siblings may have the same infectious agent may have the same infectious agent involved in patient care – education about transmission and IC principles involved in patient care – education about transmission and IC principles

9 IC Issues specific to Paediatrics Types of pathogens and sites of nosocomial infection differ from adults. Types of pathogens and sites of nosocomial infection differ from adults. Most common nosocomial infections (paediatrics): Most common nosocomial infections (paediatrics): Viral infections of the upper respiratory tract Viral infections of the upper respiratory tract Viral infections of the gastrointestinal tract Viral infections of the gastrointestinal tract Most common nosocomial infections (adults): Most common nosocomial infections (adults): UTI UTI

10 IC Issues specific to Paediatrics Neonatal and ICU Neonatal and ICU Bacteraemias are the most common source of nosocomial infection Bacteraemias are the most common source of nosocomial infection Adult ICU Adult ICU The lower respiratory tract is the The lower respiratory tract is the most common source of nosocomial infection Alexis, M. Steps to Reduce Nosocomial Infections in Children, Infectious Medicine, 2002, 19 (9):

11 Incidence of Nosocomial Infection Incidence varies by age and hospital unit: Incidence varies by age and hospital unit: Range: 0.2% % Range: 0.2% % Paediatric ICU23.5% Paediatric ICU23.5% Haematology Unit8.2% Haematology Unit8.2% Neonatal Unit7.0% Neonatal Unit7.0% General Paediatric Unit1.0% General Paediatric Unit1.0% Highest in children aged 23 months or younger Highest in children aged 23 months or younger Alexis, M. Steps to Reduce Nosocomial Infections in Children, Infectious Medicine, 2002, 19 (9):

12 Additional Length of Stay Duration of hospitalisation is longer for children with nosocomial infections Duration of hospitalisation is longer for children with nosocomial infections Paediatric ICU Paediatric ICU 26.1 days vs 10.6 days 26.1 days vs 10.6 days General Paediatric Units General Paediatric Units 9.2 days vs 3.5 days 9.2 days vs 3.5 days Attributable cost of infection $13,000 Attributable cost of infection $13,000 Alexis, M. Steps to Reduce Nosocomial Infections in Children, Infectious Medicine, 2002, 19 (9):

13 Spread of Infection Sources of infections Sources of infections The host’s own (endogenous) flora The host’s own (endogenous) flora The hand’s of health care workers The hand’s of health care workers Inanimate objects (fomites) Inanimate objects (fomites) After being exposed to an infectious agent: After being exposed to an infectious agent: Some people already have immunity and therefore don’t develop an infection Some people already have immunity and therefore don’t develop an infection Some people become asymptomatic carriers Some people become asymptomatic carriers Other people develop clinical disease (ie infection) Other people develop clinical disease (ie infection)

14 Spread of Infection The Susceptible Host The Susceptible Host Varies with age Varies with age Underlying medical conditions Underlying medical conditions Nutritional status Nutritional status Drug therapy Drug therapy Trauma Trauma Surgical procedures Surgical procedures Invasive or indwelling devices Invasive or indwelling devices Therapeutic and diagnostic procedures Therapeutic and diagnostic procedures

15 Spread of Infection 3 main routes of transmission 3 main routes of transmission Contact Contact Direct / Indirect Direct / Indirect Most frequent means of transmission Most frequent means of transmission Droplet Droplet Generated during coughing, sneezing, talking and during certain procedures such as suctioning Generated during coughing, sneezing, talking and during certain procedures such as suctioning Airborne Airborne Generated by coughing, sneezing, OR by mechanical respiratory aerosolisers, OR by air currents Generated by coughing, sneezing, OR by mechanical respiratory aerosolisers, OR by air currents

16 Standard Precautions Apply to: Apply to: Blood Blood Non-intact skin Non-intact skin Mucus membranes Mucus membranes All body fluids (including sweat) All body fluids (including sweat) Regardless of whether there is visible blood or body fluids Regardless of whether there is visible blood or body fluids

17 Hand Hygiene The single most effective method in the prevention of disease transmission The single most effective method in the prevention of disease transmission Healthcare workers think they wash their hands more than what they do Healthcare workers think they wash their hands more than what they do 80 % hospital acquired infections are thought to be transmitted by hands 80 % hospital acquired infections are thought to be transmitted by hands

18 Hand Hygiene Soap and Water Soap and Water mechanical removal of most transient flora and soil mechanical removal of most transient flora and soil minimal microbial kill minimal microbial kill no sustained activity no sustained activity 15 seconds 15 seconds

19 Hand Hygiene Antimicrobial Soaps Antimicrobial Soaps removes soil, removes transient and reduces resident flora removes soil, removes transient and reduces resident flora may have sustained activity may have sustained activity 15 seconds (antiseptic handwash) 15 seconds (antiseptic handwash) 60 seconds (clinical handwash) 60 seconds (clinical handwash) 2 minutes (surgical scrub) 2 minutes (surgical scrub)

20 Hand Hygiene Alcohol Handrubs / Gels Alcohol Handrubs / Gels very rapid kill very rapid kill destroys transient and reduces resident flora destroys transient and reduces resident flora no residual activity (except with antiseptic) no residual activity (except with antiseptic) will not remove or denature soiling will not remove or denature soiling 15 seconds 15 seconds

21 Personal Protective Equipment Eye and/or facial protection (glasses, goggles, face shields) Eye and/or facial protection (glasses, goggles, face shields) Gloves Gloves Gowns Gowns Masks Masks Assess the likely hood of contamination and prepare accordingly Assess the likely hood of contamination and prepare accordingly

22 Assessment of Risk Factors Your knowledge or experience with the situation or procedure Your knowledge or experience with the situation or procedure The likely hood of exposure to blood or body fluids at the time The likely hood of exposure to blood or body fluids at the time The patients ability to cooperate through out the procedure The patients ability to cooperate through out the procedure

23 Additional Precautions May include: May include: Single room accommodation (ensuite for some) Single room accommodation (ensuite for some) Special ventilation (negative, positive pressure) Special ventilation (negative, positive pressure) Special room cleaning Special room cleaning Dedicated patient equipment Dedicated patient equipment Rostering of immune staff Rostering of immune staff Extended sterilization (or use of disposable equipment) Extended sterilization (or use of disposable equipment) Cohorting may be considered Cohorting may be considered

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26 Multi-resistant organisms (MRO) MRSA: Methicillin resistant Staphylococcus aureus MRSA: Methicillin resistant Staphylococcus aureus VISA: Vancomycin intermediate Staphylococcus aureus VISA: Vancomycin intermediate Staphylococcus aureus VRSA: Vancomycin resistant Staphylococcus aureus VRSA: Vancomycin resistant Staphylococcus aureus VRE: vancomycin resistant enterococci VRE: vancomycin resistant enterococci ESBL: Extended spectrum beta-lactamase ESBL: Extended spectrum beta-lactamase MRGN: Multi-resistant gram negative MRGN: Multi-resistant gram negative MRPA: Multi-resistant Pseudomonas aeruginosa MRPA: Multi-resistant Pseudomonas aeruginosa MRAB: Multi-resistant Acinetobacter baumanii MRAB: Multi-resistant Acinetobacter baumanii

27 Multi-resistant organisms (MRO) Difficult to treat and control Difficult to treat and control Have the ability to cause infections, particularly in susceptible people Have the ability to cause infections, particularly in susceptible people Have the ability to cause wound infections, bacteraemias and IV line sepsis Have the ability to cause wound infections, bacteraemias and IV line sepsis Can cause significant morbidity and mortality Can cause significant morbidity and mortality Increased community awareness and expectations Increased community awareness and expectations

28 Factors that contribute to the acquisition of MROs Staff - inadequate handwashing Staff - inadequate handwashing Environmental - inadequate cleaning Environmental - inadequate cleaning Prolonged or inappropriate antibiotic treatment Prolonged or inappropriate antibiotic treatment Close proximity to a MRO patient Close proximity to a MRO patient Extended hospital stay Extended hospital stay Co-morbidities Co-morbidities ICU / Burns Unit ICU / Burns Unit

29 Respiratory Syncitial Virus Highly contagious and nosocomial infection common Highly contagious and nosocomial infection common Causes upper and lower respiratory infection Causes upper and lower respiratory infection Usually occurs during winter Usually occurs during winter No vaccine at present No vaccine at present Can be re-infected during the same season Can be re-infected during the same season Transmitted by contact or droplet Transmitted by contact or droplet Can survive for several hours in the environment Can survive for several hours in the environment

30 Respiratory Syncitial Virus

31 Rotavirus Highly contagious and nosocomial infection is common Highly contagious and nosocomial infection is common Usually a winter disease but pattern changing Usually a winter disease but pattern changing Onset is sudden and lasts for days Onset is sudden and lasts for days Mainly infants and children up to 3 years affected Mainly infants and children up to 3 years affected Transmitted usually through contact Transmitted usually through contact Can survive in environment for several hours Can survive in environment for several hours

32 Rotavirus

33 Pertussis Bacterial infection caused by Bordetella pertussis Bacterial infection caused by Bordetella pertussis Most dangerous to under 3 year olds Most dangerous to under 3 year olds Contagious for 3 weeks or for 5 days after commencing erythromycin Contagious for 3 weeks or for 5 days after commencing erythromycin Transmitted by contact and droplet Transmitted by contact and droplet Symptoms - runny nose, cough, which may develop into a whooping cough Symptoms - runny nose, cough, which may develop into a whooping cough High particulate mask when in contact with patient High particulate mask when in contact with patient

34 Pertussis

35 Meningococcal Disease Bacterial infection caused by Neisseria meningitidis Bacterial infection caused by Neisseria meningitidis Transmitted by contact or droplet Transmitted by contact or droplet Non infectious after 24 hours of appropriate antibiotic therapy Non infectious after 24 hours of appropriate antibiotic therapy Significant contacts traced and may be given prophylaxis Significant contacts traced and may be given prophylaxis

36 Meningococcal Disease

37 Measles Complications more common and severe in chronically ill and very young children Complications more common and severe in chronically ill and very young children Transmitted by droplet and contact with respiratory secretions Transmitted by droplet and contact with respiratory secretions Infectious for 4 days before and after rash Infectious for 4 days before and after rash Vaccination available Vaccination available Notifiable disease Notifiable disease

38 Measles

39 Rubella In early pregnancy risk of teratogenic damage to fetus In early pregnancy risk of teratogenic damage to fetus Infectious for 7 days before and days after onset of rash Infectious for 7 days before and days after onset of rash Infants with congenital rubella may shed virus for several months or years Infants with congenital rubella may shed virus for several months or years Transmitted by droplet route Transmitted by droplet route Vaccination available Vaccination available Notifiable disease Notifiable disease

40 Rubella

41 Varicella Zoster Virus Chicken Pox Highly contagious Highly contagious Most cases in children, over 90% of adult population is immune Most cases in children, over 90% of adult population is immune Transmitted by droplet and contact Transmitted by droplet and contact Infectious 2 days prior and days after rash Infectious 2 days prior and days after rash Now a notifiable disease Now a notifiable disease Vaccination now available Vaccination now available

42 Varicella or Chicken-pox

43 Congenital varicella Caused by maternal varicella in early pregnancy (ie <20 weeks) Caused by maternal varicella in early pregnancy (ie <20 weeks) Risk of acquiring congenital varicella syndrome is 1 - 2% Risk of acquiring congenital varicella syndrome is 1 - 2% Range and severity of symptoms vary greatly depending on when maternal varicella infection occurred Range and severity of symptoms vary greatly depending on when maternal varicella infection occurred intrauterine growth retardation, skin abnormalities, incomplete development of fingers/toes. Brain degeneration, nervous system damage, eye abnormalities intrauterine growth retardation, skin abnormalities, incomplete development of fingers/toes. Brain degeneration, nervous system damage, eye abnormalities

44 Congenital varicella

45 Parvovirus B19 Usually a mild rash disease Usually a mild rash disease Also called Fifth Disease or “Slapped - Cheek” Also called Fifth Disease or “Slapped - Cheek” Infectious prior to the rash Infectious prior to the rash Transmitted by droplet route Transmitted by droplet route

46 Parvovirus B19


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