Opportunities of Improvement in Infection Control at Outpatient Department

1. Opportunities of Improvement in Infection Control at Outpatient Department Presented By: Sony kumari

2. Max Healthcare Profile • Max India Limited is a public limited company founded in 1985 by Mr. Analjit Singh,(Founder &Chairman, Max India). • Max Healthcare commenced operations in 2001 with the intension to provide comprehensive and world class healthcare services in India. • Max Super Specialty Hospital, Saket is ideally located in South Delhi, approximately 10 kilometers from the airport. It is easily accessible from all the satellite townships of Delhi, NCR. • Max Healthcare Saket is divided into two wings Max Super Speciality Hospital, East Block and Max Super Speciality Hospital, West Block.

3. Max Healthcare Profile Max Healthcare – Caring for you……. for life. Passion of Max Healthcare : Build Trust Vision of Max Healthcare : Deliver world class healthcare with a service focus, by creating an institution committed to the highest standards of medical and service excellence, patient care, scientific knowledge and medical education.

4. Max Healthcare Profile Mission of Max Healthcare • Create unparalleled standards of medical and service excellence • Care provider of First Choice • Principle choice for physicians • Ethical practices • Create national centre of excellence for select super-specialities • Build towards International “reach” by creating patient confidence through professional skills, research and technology

5. introduction An infection is an invasion and multiplying of pathogenic microbes in the body tissues in which they are usually not present. Pathogenic means capable of causing disease. Infection does not always cause a disease. Causes of Infections Infections are caused by microbes: • Bacteria, likeSalmonella,Mycoplasma • Viruses, like virus influenza or HIV • Fungi, like one-cell yeasts  • One-cell parasites (protozoa)

6. Introduction Outpatient Settings are a prime locator for the spread of infectious diseases to staff, patients and visitors. Every year, many lives are lost because of the spread of infections in hospitals. These infections are a result of treatment in a hospital or a healthcare service unit. Hospitals and health care workers can take steps to prevent the spread of infectious diseases. These steps are part of infection control and are known as Standard Precautions for Infection Prevention.

7. Modes of Transmission of Infection • Direct Transmission : Droplet Infection : These transmitted droplets can cause many respiratory infections, eruptive fevers, many infections of the nervous system, common cold, diphtheria, whooping cough, tuberculosis etc • Indirect Transmission : Air- borne : Droplet Nuclei and Dust can cause influenza, tuberculosis, chickenpox and pneumonia. fomite- borne : diphtheria, typhoid fever, hepatitis and Eye and Skin infection. Unclean Hands and Fingers : Typhoid Fever, Dysentery, Hepatitis A

8. Inter-relationship of source of infection Droplet Other Patient Dust Patient Fomite Hospital Personnel Unclean Hands and Fingers

9. Modes of Prevention of Infection in OPD (STANDARD PRECAUTIONS) • Hand Hygiene • Personal Protective Equipment • Respiratory Hygiene and Cough Etiquette • Injection Safety • Medication Storage and Handling • Cleaning and Disinfection of Medical Equipment • Environmental Cleaning

10. RATIONALE OF THE STUDY Infections remains a major cause of morbidity and mortality among patients. . Infection Prevention must be made a priority in any setting where healthcare is delivered. The purpose of this Study is to study Opportunities of improvement in Infection Prevention at Outpatient Department. This study focuses on the core measures to prevent the spread of infectious in outpatient department and made me learn about infection control and prevention measure for outpatient settings.

11. OBJECTIVE General Objective To assess the opportunities of improvement in Infection prevention in OPD. Specific Objective • To study and identify the modes of transmission of infection in OPD. • To study the modes of prevention of infection (Standard Precautions) in OPD. • To suggest the management how to improve the Infection Prevention Program in the organization.

12. METHODOLOGY • Study Design: Cross-Sectional and Descriptive Study • Study Area : Max Super Specialty Hospital, East Block Saket • Sample Selection: Convenient sampling was done in order to obtain necessary information. • Study Tools: Structured Checklist • Duration of Study: 2 months • Technique : 1. In-depth interview and informal discussion with the staff nurses, lab technicians and housekeeping staffs by the use of checklist regarding infection control measures. 2. Observations

13. Data Interpretation of ENT OPD

14. Data Interpretation of Pediatric OPD

15. Data Interpretation of Oncology OPD

16. Data Interpretation of Neurology OPD

17. Data Interpretation of Ortho OPD

18. Data Interpretation of Obstetric and Gynecology OPD

19. Data Interpretation of Pulmonary OPD

20. Data Interpretation of Cardiology OPD

21. Data Interpretation of Dental OPD

22. Data Interpretation of Nephrology OPD

23. Findings • The hospital environment is visibly clean, free from dust and soilage, and acceptable to patients and their visitors and staffs. • The compliance of Respiratory and Cough Etiquette is very low among the HCP and Patients. • Lack of Isolation facility in OPD waiting area for the patients with symptoms of Respiratory Infection. • Hospital is following standard precaution to prevent the infection but all staff members of the Max Healthcare are not practising it regularly.

24. Findings • Factors for low compliance are as follows:- - Often HCP are too busy and don’t have sufficient time. - Patient needs take priority for care. - Hand hygiene interferes with HCW-patient relationship. - Use of gloves interferes in identification of veins.

25. Findings • No signs/ posters are there at the entrance of facility to instruct the patients with symptoms of respiratory infection to Self-report symptoms of a respiratory infection during registration. - Cover their mouths/noses when coughing or sneezing. - Use and dispose of tissues. - Perform hand hygiene after hands have been in contact with respiratory secretions.

26. Recommendations • Hospital should implement the isolation practices for hospital settings. • Specific syndromes involving diagnostic uncertainty (e.g., diarrhoea, febrile respiratory illness, and febrile rash) are routinely encountered in ambulatory settings and deserve appropriate triage. • Facilities should develop and implement systems for early detection and management of potentially infectious patients at initial points of entry to the facility.

27. Recommendations • Display respiratory hygiene posters at the entrance of the unit within the Hospital Facility (e.g. registration area at the entrance of hospitals, OPD, TB clinic, ward etc). • Few minutes repeated education sessions should be conducted related to cough etiquette and hand hygiene during the morning in all registration/waiting area/ward. • Fast-tracking of patients with respiratory symptoms must be done to reduce the total time period of stay of these patients in the healthcare facility to prevent the spread of Infection.

28. Limitations Time Constrains Due to shortage of time checklist of Infection Prevention Measures is assessed only in Max Super Specialty Healthcare , East Block .

29. EMERGENCY DEPARTMENT at Max healthcare CASE STUDY ON

30. EMERGENCY DEPARTMENT • An Emergency Department (ED), also known as Emergency Room(ER), Emergency Ward (EW) or Casualty Department (CD). • ED is a medical treatment facility, specializing in acute care of patients where patients came without prior appointment, either by their own means or by ambulance. The Emergency Department is usually found in a hospital or other primary care centre.

31. Functions of EMERGENCY DEPARTMENT • Prompt reception of all Emergency Cases and the assessment of their clinical condition. • Immediate resuscitation and other life support treatment measures including minor surgical procedures, where indicated. • Starting the investigations and treatment by the specialists concerned and calling other/senior specialists for management of the cases as required. • Provides services 24 hours a day.

32. Functions of EMERGENCY DEPARTMENT • Admitting the patients requiring admissions to the appropriate ward unit and sending back to home (after necessary investigations/treatment, observations) those not requiring admissions. • Providing ambulance service for pre-hospital care and transportation of patients to and from the hospital. • Filing the FIR, calling the police, preparing the detailed case records and preservation of body fluid samples in medico legal cases. • Rendering advice on telephone/ or in person, on simple medical queries

33. Functions of EMERGENCY DEPARTMENT • Briefing the patients/their relatives about the patients conditions, level of seriousness and the course of treatment indicated, with a sympathetic attitude. • Maintaining records of all cases attended to in Emergency Department. • Functioning as the centre for reception, triage and management of mass casualties.

34. Objective of the Study • To study the functioning of the Emergency Services. • To study the factors which affects the service quality of Emergency Department

35. METHODOLOGY Study Design: Observational and Exploratory Study Area: Emergency Department of MAX Healthcare Source of Data: Primary Data: Observation, Interaction with Nurses, General Duty Assistant, Transport Boys and Patients. Secondary Data : Records from HIS Study Period: 2 months

36. observations • Emergency Department of MAX Healthcare is equipped with 14 beds to facilitate the patients. • There are separate dedicated phone no. and entrance to enable quick and prompt access to the department. • Immediate availability of the ambulance services at the earliest, given the distance involved. • Life saving drugs is kept at the back of reception for quick access to patients.

37. Observations • A proper register is maintained for all cases came in the hospital. • OPD services are also provided at the emergency department in between 8pm to 8am (as no OPD’s are open during this timing). Triage facility: Triage is normally the first stage the patient passes through, and most emergency departments have a dedicated area for this to take place, and may have staff dedicated to performing nothing but a triage role. RED : Life threatening YELLOW : Injured but not life threatening. GREEN : Minor injury like abrasion BLACK : Dead

38. Findings • The passage/entry for the ambulance is the same as that of other public vehicles thus creating huge traffic even resulting in the delay of the emergency care occasionally. • As per literature, if the emergency department caters 1000 patients per year, there must be a separate x-ray facility at the department, but there is no such unit at the Emergency Department. • Lack of co-ordination among the staffs of Emergency Department during peak hours due to load of patients.

39. RECOMMENDATIONS • There must be a separate passage for the entry of ambulance in order to minimize traffic at the main entrance and quick access to Emergency Care. • There must be a separate unit for X-ray at the Emergency Area. • There must be a minor OT adjacent to the Emergency Department to save the time and prompt care of patients. • During the peak hours addition staffs should be present to solve the co-ordination problem.

40. THANKYOU!!