ROUTINE INFECTION PREVENTION.ppt

8/12/2019 ROUTINE INFECTION PREVENTION.ppt

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ROUTINE

INFECTIONPREVENTION


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ROUTINE INFECTION PREVENTION

Hand washing

Universal precautions

Safe handling of sharps


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STERILISATION

Instruments must be cleaned first

Sterilize with steam autoclave or hot-air oven

Preferable over disinfection for critical

instruments


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HIGH LEVEL DISINFECTION

Boiling for 20 minutes, completely coveredwith water

Chemical: bleach 1:50 dilution for 20

minutes corrosive to stainless steel


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DISINFECTING WORK AREAS

Clean dirty areas with detergent

Disinfect area with bleach 1:100

dilution

Wear gloves

Exam tables should be disinfected

daily


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Infection


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Objectives

definition

predisposing factors

pathophysiology

clinical features

sites of postpartum infection

treatment

prevention


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Definition:

any patient with fever of 38.5C 48-72 hours

following a vaginal or forceps delivery withuterine tenderness


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Incidence and scope:

- major cause of maternal death in emerging

countries- less frequent with vaginal births

- complications include: shock, pelvic abscesses

and pelvic thrombosis


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Pathophysiology

- normal flora of genital tract contains potential

pathogens

- amniotic fluid and increase in white blood

cells during labour


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Predisposing factors

- trauma and tissue necrosis following deliver

creates a culture medium for ascending

- cesarean section is most important predisposing

- prolonged labour and ruptured membranes

- poverty and poor hygiene/nutrition


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Bacteria- polymicrobial

- most common:

Escherichia coli, Kelbsiella, Proteus andBacteroides fragilis

- less common:

Clostridium, Staphylococcus aurea andPseudomona

- exogenous source:

Group A beta-hemolytic streptococci


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Clinical Features- usually 2-3 days post partum

- low grade temperature, lower abdominal pain

and uterine tenderness- also: malaise, anorexia, foul lochia

- if severe: high temperature and generalized

peritonitis


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Clinical Features

- Group A beta-hemolytic stretpococci may be

fulminant with peritonitis and septicemia

- if cultured, hospital personnel must be screened

to try and identify the source


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Diagnosis

- sites of infection to consider in post partum patient

(culture if able):

endomyometritis

urinary tract

episiotomy site

abdominal incision

breast

thrombophlebitis: legs, pelvis

appendicitis

other: upper respiratory infection


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Management - Prevention

- correct aseptic technique

- antibiotic use in women with cesarean section

or prolonged rupture of membranes (1g

ampicillin IV given prophylactically in

cesarean section reduces infection)


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Management -- Treatmentmild case: single broad spectrum antibiotic (eg.

ampicillin 1 g IV q6h Or orally)

if cesarean section:flagyl 500 mg q8h + cefoxitin 2g q6h

OR

aminoglysocide (gentamycin or tobramycin) 60-100 mg q8h +clindamycin 900 mg q8h


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Management - Treatment

if intravenous antibiotics used, continue for 48

hours after fever has stopped.

if fever continues and aminoglycoside-clindamycin

combination was used, add penicillin (5M units

q6h) to cover enterococci

oral antibiotics should be used for 5 days


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Other issues

- the more antibiotics used, > the higher the

chance of necrotizing colitis

- antibiotics do appear in breast milk but in most

cases are not clinically significant (avoid

tetracyclines)


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Specific issues:episiotomy infection: treat with antibiotics, baths

(clean water!), heat

- remove sutures if fluctuation or pus

- rarely needs debridement

necrotizing fascitis: rare, rapid progression of local

inflammation followed by gangrene -patient is toxic:high dose antibiotics but MUST surgically

DEBRIDE


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Other issues

- Septic pelvic thrombophlebitis--usually anaerobic

sepsis

- usually patient is already on antibiotics butcontinues to have high spiking fevers

- diagnosis of exclusion

- treatment is intravenous heparin

- > condition should respond to heparin


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Other issues

- Mastitis--penicillin G or penicillinase-resistant

(methicillin or cloxacillin)

for 7-10 days

continue breast feeding!

if breast abcess--drain


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Special case:

Postpartum or postabortal septic shock

definition: any toxic patient who has

hemodynamic or acid base changes with fever

38.5C (after abortion, vaginal or operative

delivery)


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Etiology of postpartum/postabortal shock

- usually gram-negative bacteria (eg. E. Coli) and

occasionally gram positive (staphylococci,

anaerobic streptococci, clostridium)


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Pathophysiology of postpartum postabortal

shock

- not fully understood

- endotoxins from cell wall of bacteria initiate

vascular damage and vasodilatation

- hypotension / hypoperfusion


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Conclusions

- major problem

- proper diagnosis

- early and aggressive treatment

- prevention


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Oral Anti retroviral treatment

Antepartum Intrapartum Post partum

For mother

neonatal

1.AZT300mgs

p.o B.D after 35weeksgestation

AZT300mgs p.o

3hourly tilldelivery

AZT300mgs p.o

B.D for 7 days

4mgs/kg p.o B.D

for 7 days

2. None NVP200 mgs p.pat onset of labour

none 2mgs/kg p.o 48-72 hours


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Post natal care

Dual use of Contraception( Barrier&

contraception).

Ongoing Care

Counseling and support

Care of the Neonate,(Exclusive breast

feeding for 3/12 months or Artificialinfant feeding)


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Conclusion

Maternal to child transmission can be

reduced by 50%

Effective counseling ,support,treatment

of opportunistic infections and anti

retroviral treatment can improve qualityof life.

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ROUTINE INFECTION PREVENTION.ppt