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Embedding Ipc in Clinical Practices In Primary Care With A Focus On Maternal And Child Health PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Embedding IPC in clinical practices in primary care with a focus on maternal and child health” by Howard L Sobel, MD, PHD, MPH.

This medical PowerPoint presentation tells how infection prevention and control (IPC) is a critical component of clinical practices in primary care, particularly in maternal and child health. Effective IPC measures can help prevent the spread of infectious diseases and reduce the risk of adverse outcomes for both mothers and children.

Tags : infection prevention and control, primary care, maternal and child health, Neonatal-Perinatal Medicine, Neonatal-Perinatal Medicine PowerPoint presentation

Published on : Jun 07, 2023 | Views : 723 | Downloads : 1

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Slide 1-

Embedding IPC in clinical practices in primary care with a focus on maternal and child health Howard L Sobel, MD, PHD, MPH Regional Advisor, RMNCH, IPC, Clinical Management, Patient Safety Friday, 15 October 2021 14:00-15:30 CET │ 8:00-9:30am EDT Strengthening IPC in primary care: a new era starts today 1
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Infection prevention and control (IPC) for neonates What typical clinical practices contribute to or prevent neonatal sepsis? 2
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Ospital ng Makati partially closed for cleanup 25 babies reportedly died due to infection By Julie M. Aurelio, Kristine L. AlavePhilippine Daily InquirerFirst Posted 01:42:00 06/07/2008 MANILA, Philippines – The neo-natal intensive care unit, nursery and delivery areas of the Ospital ng Makati (OsMak) will be partially closed as sanitation measures are now underway following several reports of infant deaths in the facility. Dr. Eric Tayag of the Department of Health’s National Epidemiology Center however said the sanitation measures were standard procedures, and were not undertaken because they were accusing the hospital of negligence. This 2008 neonatal sepsis outbreak in the Philippines started us on a journey that helped improve newborn care, now in 28 countries In supporting Philippines, I reflected that I did many harmful practices to my newborn son (in 1997) and hundreds of others 3
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“Half of what we are going to teach you is wrong, and half of it is right. Our problem is that we don’t know which half is which.” Dr. Sidney Burwell, Dean, Harvard Medical School 1935-1949 4
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Source: Sobel et al, Acta Paediatrica (2011), Philippines Which of these practices contributes to neonatal sepsis? Suctioned Philippines: documenting practices subsequently found in all our priority countries 5
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FIRST, DO NO HARM Do not suction unless baby is: 1. born through meconium and 2. not breathing No proven benefit except if air passage blocked Delays other essential actions Can cause vasovagal stimulation Infection https://apps.who.int/iris/bitstream/handle/10665/75157/9789241503693_eng.pdf?sequence=1 6
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Immediate Thorough Drying Immediate drying Stimulates breathing Prevents hypothermia Hypothermia which can lead to Infection Coagulation defects Acidosis Delayed fetal to newborn circulatory adjustment Hyaline membrane disease Brain hemorrhage Tunell R., in Improving Newborn Health in Developing Countries; A. Costello and D. Manandhar, Editors. 2000, Imperial College Press: London, UK. p. 207-220; Tollin M, et al.. Cell Mol Life Sci 2005; Safari, K., Saeed, A.A., Hasan, S.S. et al. Int Breastfeed J 13, 32 (2018). https://doi.org/10.1186/s13006-018-0174-9 7
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Hypothermia which can lead to infection, coagulation defects, acidosis, delayed fetal to newborn circulatory adjustment, hyaline membrane disease, brain hemorrhage Infection The vernix is a protective barrier to bacteria such as E. coli and Group B Strep; so is maternal bacterial colonization No crawling reflex Early Bathing Can Lead to: Tunell R., Cell Mol Life Sci 2005; 62:2390-99; Righard L, Alade M. Lancet 1990; 336: 1105-07. https://www.dreamstime.com/photos-images/newborn-baby-first-bath.html 8
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Skin-to-Skin Contact Contributes to: Warmth Bonding Successful breastfeeding/colostrum feeding Stimulate the mucosa-associated lymphoid tissue system Calmness Protection from hypoglycemia Colonization with maternal skin flora Moore ER, Bergman N, Anderson GC, Medley N. Early skin‐to‐skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews 2016, Issue 11. Art. No.: CD003519. DOI: 10.1002/14651858.CD003519.pub4. Accessed 13 October 2021; Brandtzaeg. Ann N Y Acad Sci 2002 9
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Figure 1. Association of SSC duration and early initiation of breastfeeding. Increased duration of skin-to-skin contact was associated with higher likelihood of timely initiation of breastfeeding Li Z, Sobel HL, Western Pacific Region Early Essential Newborn Care Working Group, et al. BMJ Global Health 2020;5:e002581. 10
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Baguio General Hospital, Philippines, 1973-1977 Period I: Neonates were not rooming-in with their mother The hospital allowed formula Many cases of neonatal sepsis Clavano, J Trop Ped, 1982 Period II: Neonates roomed-in with their mother; breastfeeding policy promoted 89% reduction of neonatal sepsis and 95% neonatal sepsis deaths 11
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Delaying Initiation of breastfeeding increases risk of infection-related death Nepal 2008 N = 22,838 breastfed babies Mullany LC, et al. J Nutr, 2008; 138(3):599-603. 12
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“The United States overall could save about $13 billion annually through improved exclusive breastfeeding alone.” 13
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The benefits of breastfeeding Long-term benefits for life Short-term benefits for the first 6 months 63% less diarrheal infections 72% less hospitalizations 77% less diarrhea mortality 57% less respiratory infections 67% less respiratory hospitalization 70% less respiratory mortality Higher IQ Better school performance 34% less type-2 diabetes 24% less obesity Sources: WHO (‎2013)‎ Short-term effects of breastfeeding: a systematic review on the benefits of breastfeeding on diarrhoea and pneumonia mortality; WHO (2013) Long-term effects of breastfeeding: a systematic review 14
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WHO Recommendations on interventions to improve preterm outcomes: Kangaroo Mother Care (KMC) “Continuous KMC was associated with a 40% lower risk of mortality at the time of discharge or at 40–41 weeks postmenstrual age compared to conventional care (RR 0.60, 95% CI 0.39–0.92; 3 studies, 1117 babies).” https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/preterm-birth-guideline/en/ 15
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Other common IPC problems during maternal and newborn care Co-bedding (maternal and newborn) Unnecessary Separation Handling Frequency of pelvic exams Unhygienic surfaces Wearing rings Cell phone use during patient care Footprint ink pads WASH (below) 16
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The Action Plan for Healthy Newborn Infants in the Western Pacific (2014 – 2020) Goal: To eliminate preventable newborn mortality by providing universal access to high-quality early essential newborn care (EENC) Targets: At least 80% of facilities where births take place are implementing EENC At least 90% of births in sub-national areas are attended by SBAs NMR ≤ 10 per 1000 live births - National & sub-national 17
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What is Early Essential Newborn Care (EENC)? 18
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A data driven and systems approach to introducing and scaling-up EENC Module 2 Module 4 Module 3 DRAFT Module 1 Biennial programme reviews & planning (national level) 19
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A data driven and systems approach to introducing and scaling-up EENC Hospital-level assessment Observation of hospital environments Review policies and guidelines Review availability of essential medicines and supplies Review staff training status System-level changes Identify priority actions Develop action plans Allocate resources Regular M&E Influence national policy and strategy Client-level assessment Interview of caregivers Chart reviews 20
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34,655 health facility staff have been coached in EENC Health workers coached on EENC 21
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Early essential newborn care in the Western Pacific Region Data from nine priority countries 5,955 health facilities have introduced EENC ≈ 87% of facilities providing childbirth services have introduced EENC in eight priority countries (excluding China) Outputs Outcomes 91% receiving SSC 78% EBF 48% ≤2000g receiving KMC 22
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From WPRO to other regions Introducing the WPRO EENC approach in the SEARO, EMRO and AFRO regions Total countries: 28 23
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Early essential newborn care in the Western Pacific Region Impact Decreases in neonatal mortality: 33% in Cambodia (2010-2014) 44% in Lao PDR (2012-2017) 36% in Mongolia (2014-2018) 13% in the Philippines (2008-2017) Sources: Demographic Health Surveys or Social Indicator Survey Significant reductions in risk of hypothermia on NICU admission and all cause sepsis at the hospital level Source: Tran HT, Mannava P, Murray JCS et al, 2019 24
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Case study: ĐÀ NẴNG Hospital catchment: 10 million Hospital births:~15,000 25
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Feeding practice in NICU (all admissions)Da Nang, 2013-2015 (n=372 n=429) Tran HT, Sobel HL et al. Lancet E-Clinical Medicine 2018;6:51–58. 26
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NICU admission and adverse outcomes (All live births), Da Nang, 2013-2015 Tran HT, Sobel HL et al. Lancet E-Clinical Medicine 2018;6:51–58. 27
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Early essential newborn care is associated with improved newborn outcomes following caesarean section; Da Nang, Viet Nam Tran HT, Sobel HL, et al. BMJ open quality 10 (3), e001089. 28
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Average monthly cost of infant formula in NICU and postnatal wards, (2013-2015), Da Nang, Viet Nam 29
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Availability of hand washing amenities in maternal and neonatal care rooms, 147 hospitals, 7 countries, 2016-17The Environment is critical Appropriate hand hygiene was practiced for all deliveries in: 50% of hospitals where delivery rooms had a sink with water and soap 39% of hospitals where these were not available Source: Mannava, Sobel, et al, J Glob Health. 2019;9(2) 30
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Summary of gaps in WASH identified during assessments of family planning and child health service delivery Single use towels or other hygienic ways to dry hands Cleaning stethoscopes and thermometers before and between patient exams Having containers for and segregating wastes: Sharps (puncture proof) Biodegradable Non-biodegradable Recyclable 31
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Simulation exercise and skills building for establishing safe COVID-19 patient management, Lao PDR, 2020 “Germs” spread everywhere COVID-19 taught us maintaining essential health services requires carefully planned IPC including safe screening zoning PPE use referral sample collection disinfection
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Take-away messages IPC for MCH service delivery needs to be wider than “standard IPC precautions”: e.g., skin-to-skin contact, breastfeeding, KMC IPC breaches are common in maternal and newborn care Early Essential Newborn Care is associated with ¾ reduction in neonatal sepsis WASH is critical for IPC but by itself does not guarantee hand hygiene compliance COVID-19 has emphasized that IPC is critical for restoring and maintaining essential health services 33
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Mothers and babies should not get infected during healthcare: Act Now! 34