In-Hospital and Inter-Hospital Patient Referral and Infection Control
The personnel involved in patient referral within and between hospitals should first be made aware of and trained by hospital infection control committee members on hospital isolation measures. Standard precautions apply to blood, whole body secretions, excretions, skin and mucous membranes. These measures include all patients admitted to the hospital. Today it is called universal measures. Prevention measures include patients with proven or suspected infections or colonization with certain microorganisms.
These measures have been prepared for the care of all patients, regardless of the diagnosis or the estimated condition of the infection. Fulfilling standard measures is the primary strategy of success in hospital infection control. These measures are useful in reducing the risk of transmission of microorganisms that are the source of identified or unspecified nosocomial infections. Of these, washing hands or decontamination with hand disinfectants is generally indicated as the single most important measure to prevent the passage of microorganisms and reduce the risk of passage from one person to another or from one person to another. Although wearing gloves is important in hospitals, it is necessary to exchange gloves between patient contacts and wash hands after gloves are removed and decontaminate. Wearing gloves does not eliminate the need to wash hands. From hospital isolation measures, patient placement is also important in preventing direct and indirect transmission (a special room, etc.) for patients who cannot help maintain the infection control measures taken to limit the passage of microorganisms with environmental contamination.
In addition, face masks (respiratory protection, eye protection), goggles should be used to prevent contact of the mucous membranes of the eye, the mouth and nose with pathogenic microorganisms, while applying procedures that may sputter blood, body fluids, secretions and excretions. Protective clothing should be worn to provide a protective barrier and reduce the likelihood of microorganisms passing through the hospital. It is also worn when interfering or transporting to a patient infected with epidemiologically important microorganisms to reduce the risk of transmission to other patients or staff. If worn during the procedure, removed without leaving the room, contaminated with blood and body fluids should be disposed of in a medical waste bag and hands washed before leaving the room. Again, the tools and equipment used when dealing with patients require special attention and regulation. It requires special attention both during disinfection and placement. For those infected with an epidemiologically important pathogen in inpatients, additional measures as well as standard measures are required. There are three types of transitional measures. Airway precautions, droplet precautions and contact precautions.
Airway precautions: Monitored, negative pressure, specially ventilated rooms should be used. If the patient is going to be transferred from one room to another, an isolation mask must be worn. The room should usually be kept closed, and everyone who comes in should wear a respirator. Tuberculosis, rubeola varicella and so on. airway infections.
Droplet precautions: Droplet passage should not be confused with airway passage. A surgical isolation center should be used by persons who are within 3 m of the patient within the scope of droplet precautions, or by those who care directly with the patient. Patients should be allowed to leave the room only for the most necessary cases, and if the transplant is absolutely necessary, a surgical mask should be worn.
Infections requiring droplet prevention; mumps, whooping cough, meningococcal meningitis, Haemophilus influenzae infection (neonatal and pediatric pneumonia), influenza virus infection.
Importance of contact : Transition by direct contact is a very important and common form of transition, including indirect contact. Again, contact measures should be applied in addition to standard measures. In particular, these types of patients should be treated by wearing gloves and non-sterile gowns properly, hands should be washed without leaving the room and without contact with clothing. If it does not come into contact with blood and body fluids, it should be disposed of in different, if so, medical waste bags. Patient transport should be restricted to allow exit from the room only when necessary. If the patient is to be transported, precautions should be taken to minimize the risk of microorganism penetration to other patients, environmental surfaces and equipment. The equipment used in dealing with the patient should be dedicated to the use of a single patient as much as possible within the framework of contact precautions. Contact precautions should be applied to patients known or suspected to be ill in the following cases. Patients infected or colonized with multi-drug resistant microorganisms with Clostridium difficile enterocolitis, major infected wounds and pressure ulcers, respiratory syncytial virus (RSV), ebola virus infections.
Procedures to be applied in in-hospital and inter-clinic patient transport
1. Personnel to transport the patient should use the necessary equipment and clothing to prevent contamination of skin and clothing without placing the patient in a stretcher or wheelchair.
2. A clean sheet should be covered over the transport vehicle. If the vehicle can be contaminated with blood or body fluids, a disposable disposable pad should be laid on it.
3. After placing the patient on a stretcher or wheelchair, a clean sheet should be covered.
4. Personnel should remove the protective clothing, including gloves, used by them during transport on their way out of the room and wash their hands.
5. In particular, gloves that contact the patient should not be used during transport.
6. If the patient has persistent cough and sneezing, the patient should be provided with a clean box of tissue paper and a plastic bag to dispose of
7. An extra apron, a clean bed sheet, a waterproof disposbl pet should be carried in tow to be used to the patient when required.
8. If the patient is not capable of contaminating the vehicle with blood or body fluids, no action other than hand washing is necessary.
9. When the patient arrives at the other care unit, the carrier should check that the transport vehicle is contaminated with blood or body fluids. If contaminated, clean the vehicle with disinfectant.
10. Infected patients should not be referred to another service unless it is very necessary.
Patients should also be prevented from moving between services. For example; transport and isolation of critically ill patients to single rooms carries various risks. The available data show that isolation rules need to be reviewed in intensive care units where methicillin-resistant Staphylococcus aureus (MRSA ) carriers are endemic. Cross-infection cannot be reduced by taking MRSA-positive patients into single rooms, and more effective ways to reduce the spread of MRSA should be tried. Patients infected with vancomycin-resistant enterococci (VRE) should not leave their chambers as much as possible. Before leaving the room, the patient should wear a clean apron and wash his hands with an antimicrobial soap (chlorhexidine, etc.). The team carrying the patient must be informed about the patient's condition. Any equipment or articles touched by the patient should then be cleaned with disinfectant. The patient should avoid touching the general surfaces (oven, television, etc.), using the public places (kitchen) and being in places such as cafeteria and living room. After the patient is taken to a stretcher or wheelchair, the carrier personnel should leave their aprons and gloves in the patient's room and wash their hands before starting to move. Contacted gowns and gloves should not be used outside the room during routine VRE patient transport.
In addition to standard precautions, respiratory (airway) and droplet precautions should be taken in all patients with symptoms of respiratory infections in inter-hospital patient transfers . For example; Transplant personnel who are thought to be infected with SARS (severe acute respiratory syndrome) should be informed and experienced in the prevention. Such patients can be transported safely in any emergency vehicle (ambulance) if certain appropriate measures are taken. These;
1. During transport, patient and carrier personnel should wear surgical (high-protective) masks.
If it is not possible for the patient to wear a surgical mask, if the respiratory condition does not allow, the patient should cover his mouth / nose with a tissue when coughing.
2. Where possible, the driver and patient compartments must be separated from the vehicles and have different (separate) ventilation systems. The window or door between these compartments should be closed after the patient has entered the vehicle.
3. Ventilation of the vehicle should be such that it cannot recirculate repeatedly, so that the maximum volume of air entering the vehicle from outside. If there is a fan, the fan must be set up so that the air flows from the drive part to the patient part and then the air comes out. Some vehicles have circulation ventilators that pass air through HEPA filters without returning the vehicle to the vehicle. If there are no separate compartments in the vehicle and ventilation has to be used, open air vents are opened in the driver's area and the fans for air outlet are set to the highest setting. This creates a negative pressure gradient in the patient area.
4. Pre-hospital interventions should be avoided from procedures that cause coughing (mechanical ventilator, nebulizer).
5. Disposable aprons, gloves, eye protection and high efficiency respirator (high efficiency respirator) are provided for the safety of transport personnel. After the transport is completed, all such material should be treated as medical waste. Reusable patient intervention devices should be cleaned and disinfected according to the manufacturer's instructions. Every patient contact (inside the ambulance) must be thoroughly cleaned and disinfected. As a result, in inter-clinic and inter-hospital patient transfers, first of all the personnel in charge (physician, nurse, caregiver, etc.) should be educated and disciplined in order to apply the universal precautions and / or transmission route related to patient information.
11AXX
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