hospital acquired infections bydr. atiullah khan
TRANSCRIPT
HOSPITAL ACQUIRED INFECTIONS
BY Dr. ATIULLAH KHAN MIMER medical college
DEFINITION Infections that develop within a hospital or
are produced by microorganisms,acquired during hospitalization, within 48hrs.
Also called as “NOSOCOMIAL INFECTIONS.”
‘Nosus’ means disease.
‘Kameion’ means to take care of.
DEFINITION BY C.D.C Infections that the patients acquire during the course of receiving treatment for other conditions, or acquired by the Healthcare Workers while performing their duties in healthcare settings.
Public health importance Major public health problem
Incidence -2% to 12% in developed countries
The incidence depends on type of hospital, type of patients and type of surgeries performed
STATUS IN INDIARisk of infections in India.
[Current scenerio as per apiindia.org]
Approx. 19,900 neonatal deaths/year due to sepsis.
5-10% of patients admitted to acute care hospitals acquire infections.
2 million patients/year affected.
90,000 deaths/year
1/4th of nosocomial infections occur in ICUs.
70% are due to antibiotic resistant organisms
Factors Influencing H.A.I. The microbial agent
Patient susceptibility
Enviromental factors
HOST FACTORS
THE AGENT
EPIDEMIO-
LOGICAL INTERAC
T-ION
ENVIRONMEN
T
SOURCES OF INFECTION
2 SOURCES :
EXOGENOUS• Outside the
human bodyENDOGENOUS• By Normal human
flora
• Caused by organisms acquired by exposure to hospital personnel, medical devices or hospital environment.
EXOGENOUS
INFECTIONS
• Caused by organisms that are present as a part of normal flora of the patient.
ENDOGENOUS
INFECTIONS
Richards, MJ. 1999. Crit Care Med 27; 887.
0
5
10
15
20
25
30
35
Overall ICU
UTIPneumoniaSWIBloodstreamOther
Gram +veStaphylococcus aureusStaphylococcus epidermidis
Gram -veEnterobacteriaceae Pseudomonas aeruginosaAcinetobacter baumanniMycobacterium tuberculosis
BACTERIA
Pseudomonasaeruginosa
Enterococcus
Coag-neg staphylococcl
E-coli
Staphylococcus aureus
Other
COMMON BACTERIAL AGENTS
(9%)(10%)
(11%) (12%)
(13%)
45%)
SURGICAL SITE INFECTIONS
Any purulent discharge, abscess, or spreading cellulitis at the surgical site during the month after the operation.
The infection is usually acquired during the operation itself; either exogenously (e.g. from the air, medical equipment, surgeons and other staff), endogenously from the flora on the skin or in the operative site or, rarely, from blood used in surgery
URINARY TRACT INFECTIONS
Positive urine culture (1 or 2 species) with at least 105 bacteria/ml, with or without clinical symptoms.
MOST COMMON NOSOCOMIAL INFECTION
80% of infections are associated with the use of an indwelling bladder catheter
RESPIRATORY INFECTION
Respiratory symptoms with at least two of the following signs appearing during hospitalization:
Cough Purulent sputum New infiltrate on chest
radiograph consistent with infection.
BLOOD STREAM INFECTIONS
Represent a small proportion of nosocomial infections.
Case fatality : >50% Organisms involved :
Multi resistant coagulase- negative Staphylococcus
Candida spp.
MODES OF TRANSMISSION
ROUTES OF SPREAD
CONTACT AIR BORNE
EXOGENOUS
CONTACT TRANSMISSION(MOST COMMON MODE OF TRANSMISSION)
CONTACT
DIRECT INDIRECTHANDS,AUTOINOCULATION,EQUIPMENT.
BEDPANS,DRESSINGS,CONTAMINATED GLOVES
Direct via (physical contact) Hands & clothing Droplet contact followed by
autoinoculation Clinical equipment
Indirect via contaminated articles
Bedpans, Instruments like needles, dressings, contaminated gloves,etc. bowls, jugs,
1. Contact (most common)
AIR BORNE TRANSMISSION
• DROPLET NUCLEI IN THE ATMOSPHERE
• RESPIRATORY SECRECTIONS ON SURFACE (FOMITES)
EXOGENOUS INFECTIONS SITESIN HOSPITAL-INFECTIONS
PREVENTING NOSOCOMIAL INFECTIONS
ADMINISTRATIVE MEASURES Formation of a hospital aquired “
INFECTION CONTROL COMMITTEE” to formulate the policies regarding admission of infectious cases, isolation facilities & disinfection procedures.
Formation of a CSSD (Central Sterile Supply Department) in every hospital.
Infection Control Committee
The hospital ICC is charged with the responsibility for the planning, evaluation of evidenced-based practice and implementation, prioritization and resource allocation of all matters relating to infection control.
Infection Control Nurse (ICN)
Infection Control Team
Infection Control Doctor (ICD)
Role of infection control teams
Education and training Development and dissemination of
infection control policy Monitoring and audit of hygiene Clinical audit
C.S.S.D (Central Sterile Supply Department)
Supply of sterile instrument & material for dressing & procedure carried out in the wards and departments.
Sterilization of instruments & linen for use in O.T.
Disinfection & Sterilization of medical equipment.
Selection & distribution of single use sterile supplies such as catheters, suction tubes, syringes.
Goals of infection control Ensure that health professionals
understand how pathogens can be transmitted in the working environment [patient to healthcare worker, healthcare worker to patient &patient to patient]
Apply current scientifically accepted infection control principles
Minimize opportunity for transmission of pathogens to patients and healthcare workers
ISOLATION
Infectious patients MUST be isolated.
Patients susceptible to infection should not be placed in the beds next to patients who are a source of infection.
MEASURES BY HOSPITAL STAFF Those suffering from infectious
ailments should be kept away from work until completely cured.
They should be careful about PERSONAL HYGIENE.
Aprons & Outer clothing should be regularly changed.
HAND WASHING
HAND HYGIENEHANDS ARE THE MOST IMPORTANT VEHICLES OF HAI TRANSMISSION• THOUSANDS OF PEOPLE DIE EVERYDAY FROM
INFECTIONS WHILE RECEIVING HEALTH CARE • MOST IMPORTANT MEASURE TO AVOID THE
TRANSMISSION OF HARMFUL MICROORGANISMS.
ANY HEALTHCARE WORKER/PERSON INVOLVED IN DIRECT/INDIRECT PATIENT CARE
WHY?
WHO?
5y13
Why Don’t Staff Wash
their Hands(Compliance estimated are less than
50%)
WHY DON’T STAFF WASH HANDS?
• THE COMPLIANCE ESTIMATED IS LESS THAN 50%
• SKIN IRRITATION• WEARING GLOVES• TOO BUSY FOR REGULAR HAND
WASHING• LACK OF APPROPRIATE STAFF• Being a physician
DUST CONTROL
Dust is released during SWEEPING, DUSTING & BEDMAKING.
Suppression by WET DUSTING VACUUM CLEANING
PROPER DISPOSAL OF HOSPITAL WASTE
COLOR WASTE TREATMENT
YELLOW Human & animal anatomical waste/Microbiology waste and
soiled cotton/dressings/linen/bedding
etc.
INCINERATION/ DEEP BURIAL
RED Tubing/catheters/i.v. sets etc. AUTOCLAVE/MICROWAVE/
CHEMICAL TREATMENT
BLUE/ WHITE
Waste sharps (needles,syringes,scalpels,blade
s etc.)
AUTOCLAVE/MICROWAVE/
CHEMICAL TREATMENT/
DESTRUCTIONBLACK Discarded medicines/
cytotoxic drugs/incineration ash/chemical waste
DISPOSAL IN LAND FIELDS
DISINFECTION
Disinfection prevents transmission of organisms between patients.
3 LEVELS OF DISINFECTION:
HIGH LEVEL - destroys all the microorganisms except heavy contamination by bacterial spores.
INTERMEDIATE LEVEL – inactivates M.tuberculosis, vegetative bacteria, most viruses & fungi.
LOW LEVEL – kills most bacteria, some viruses & some fungi.
STERILISATION
Operationally, defined as decrease in microbial load to 10-4.
Done for Medical devices penetrating sterile body sites Parenteral fluids Medications Reprocessed equipment
The objects must be wrapped after sterilization to maintain its viability for longer durations of time.
CONTROL OF DROPLET INFECTION
Use of face-mask
Proper bed-spacing
Prevention of overcrowding
Ensure adequate ventilation
IMPROVING NURSING TECHNIQUES
BARRIER NURSING is the effective measure.
Its Aim is to protect medical staff against infection by patients, especially with highly infectious diseases.
An attempt should be made to achieve and maintain an average count of 10-
15 bacteria/cubic foot of air in hospital.
Less than 5 bacteria/cubic foot – minimal risk of infection.
More than 35 bacteria/cubic foot – high risk of infection
Guideline to evaluate the floor cleaning procedurebased on REPLICATE ORGANISM DETECTION &COUNTING (R.O.D.A.C plate count)
0-25 bacteria/cubic foot - good floor cleaning procedure.
26-50 bacteria/cubic foot – satisfactory.
>50 bacteria/cubic foot – not satisfactory.
MANUAL STEAM STERILIZER
SEMI-AUTOMATIC STEAM STERILIZER
AUTOMATIC STEAM STERILIZER
ETO(ETHYLENE TRIOXIDE) STERILIZER
WASHER DISINFECTOR
ULTRASONIC CLEANER
GLOVE WASHER
GLOVE DRYER
GLOVE POWDERING MACHINE
BIBLIOGRAPHY Park’s Textbook of Preventive & Social
Medicine 23rd edition Prevention of Hospital Acquired Infections
WHO GUIDELINES Bennett and Brachman’s Hospital Acquired
Infections by William R. Jarvis CDC – www.cdc.gov/cdc.htm Harrisons textbook of medicine 18/e pg 1112 Hospital Administration by Francis & de ’Souza Instruments Picture from saifaee medical college
Etawah, website
THANK YOU