hospital infection control 2008
TRANSCRIPT
Philippine Hospital Infection Control Society (PHICS), Inc.
HOSPITAL INFECTION
CONTROL
Cecilia S. Montalban, MD, MScCTM
Philippine Hospital Infection Control Society (PHICS), Inc.
INFECTION• the state or condition in which the
body or part of the body is invaded by a pathogenic agent (bacteria, virus, parasites etc.) which under favorable conditions multiplies and produces injurious effects
Philippine Hospital Infection Control Society (PHICS), Inc.
NOSOCOMIAL INFECTION
• latin word “nosocomium” meaning hôspital • synonymous to hospital-acquired infection• infection acquired 48 hours after
admission to hospital (not present or incubating at the time of admission)
• acquired while in the hospital and developed after discharge
Philippine Hospital Infection Control Society (PHICS), Inc.
Common Sites of Nosocomial Infections
Urinary tract
Respiratory tract
Gastrointestinal
Blood stream
Skin, Wound, Burn
Surgical wound infection
Others
Philippine Hospital Infection Control Society (PHICS), Inc.
Factors Promoting Nosocomial Infection
ageduration of hospitalizationsurgery (type of operation)immune status: chemotherapy, radiation therapy, malignancydiagnostic technique/ proceduresenvironmentpersonnelpatient
Philippine Hospital Infection Control Society (PHICS), Inc.
The “C ST” of Nosocomial Infection
PERSONNEL
• Need for hospitalization
• Income loss
• Pain and suffering
• Disfigurement/Disability
• Death
Philippine Hospital Infection Control Society (PHICS), Inc.
The “C ST” of Nosocomial Infection
INSTITUTIONS
• Loss of revenue
• Extra duty
• Liability insurance
• Malpractice
• Reputation
Philippine Hospital Infection Control Society (PHICS), Inc.
BSI Pneumonia UTI
Extra days
confinement15 11 13
Added cost US$ 2,619
US$ 2,051 US$ 1,970
EXTRA C STS BY TYPE OF INFECTION
Rosenthal and Migone. Nosocomial Infections Costs And Extra Days In Intensive Care Units In Argentina. Prospective Cohort Matched Cases. IV Infections Control And Hospital Epidemiology Pan American Congress. 2002, Cancun, Mexico.
Philippine Hospital Infection Control Society (PHICS), Inc.
How do infections occur in hospital setting ?
AGENTAGENT
SUSCEPTIBLESUSCEPTIBLEHOSTHOST
MEANS OF MEANS OF TRANSMISSIONTRANSMISSION
Philippine Hospital Infection Control Society (PHICS), Inc.
AGENTAGENT
How do infections occur in hospital setting ?
Philippine Hospital Infection Control Society (PHICS), Inc.
AGENTS
GRAM NEGATIVE RODS
GRAM POSITIVE COCCI
OTHERS
Escherichia coli
Staphylococcus aureus
Fungi - Candida sp.; Aspergillus sp.
Klebsiella sp. Staphylococcus epidermidis
Protozoans
Pseudomonas aeruginosa
Enterococci Mycobacterium tuberculosis
Acinetobacter sp. Pneumocystis carinii
Enterobacter sp. Anaerobes
Philippine Hospital Infection Control Society (PHICS), Inc.
Sources of Agents of Nosocomial InfectionsEXOGENOUS• Hands• Instruments• Catheters• Respiratory
equipments• Transfusions• IV system• Linen• Air
ENDOGENOUS• Oropharynx• Respiratory• Gastrointestinal• Skin
Philippine Hospital Infection Control Society (PHICS), Inc.
Factors Promoting Endogenous Infections
• Operations
• Catheters
• Foreign bodies
• Chemotherapy
• Immunosuppression
• Pre-existing disease
Philippine Hospital Infection Control Society (PHICS), Inc.
AGENTAGENT
MEANS OF MEANS OF TRANSMISSIONTRANSMISSION
How do infections occur in hospital setting ?
Philippine Hospital Infection Control Society (PHICS), Inc.
Means of Transmission of Nosocomial Infections
Contact - direct or indirect
Airborne - measles, varicella, TB
Droplet - meningococcemia
Vector - insects or animals
Vehicle - food, water, blood,
medication
Philippine Hospital Infection Control Society (PHICS), Inc.
MEANS OF TRANSMISSIONOF NOSOCOMIAL INFECTIONS
CONTACTCONTACTA. Direct ContactA. Direct Contact
- occurs when one person - occurs when one person touches anothertouches another
- direct contact is an ongoing - direct contact is an ongoing process in the hospitalprocess in the hospital
- best vehicle : - best vehicle : Hands
Philippine Hospital Infection Control Society (PHICS), Inc.
MEANS OF TRANSMISSIONOF NOSOCOMIAL INFECTIONS
CONTACTCONTACTB. Indirect ContactB. Indirect Contact
- occurs when a person touches - occurs when a person touches an inanimate object an inanimate object contaminated by an infected contaminated by an infected patientpatient
Philippine Hospital Infection Control Society (PHICS), Inc.
AGENTAGENT
SUSCEPTIBLESUSCEPTIBLEHOSTHOST
MEANS OF MEANS OF TRANSMISSIONTRANSMISSION
How do infections occur in hospital setting ?
Philippine Hospital Infection Control Society (PHICS), Inc.
Factors that Increase Host Susceptibility to Nosocomial Infections
• Chronic underlying diseases• Immune deficiency states
– Malignancies– Therapeutic measures– Immunosuppression– Antibiotic therapy
• Invasive devices• Surgery• Age
Philippine Hospital Infection Control Society (PHICS), Inc.
AGENTMeans of
TransmissionSusceptible
HostBacteriaBacteriaVirusVirusFungiFungi
CONTACTCONTACTAIRBORNEAIRBORNEDROPLETDROPLETVEHICLEVEHICLEVECTORVECTOR
DiseaseDisease
Philippine Hospital Infection Control Society (PHICS), Inc.
BASIC PRINCIPLES IN INFECTION CONTROL
Philippine Hospital Infection Control Society (PHICS), Inc.
AGENTAGENT
SusceptibleSusceptibleHOSTHOST
Means ofMeans ofTransmissionTransmission
The The CHAIN of CHAIN of
INFECTIONINFECTION
Philippine Hospital Infection Control Society (PHICS), Inc.
AGENTAGENT
SusceptibleSusceptibleHOSTHOST
Means ofMeans ofTransmissionTransmission
Breaking theChain of Infection
Philippine Hospital Infection Control Society (PHICS), Inc.
• The hands should be washed after handling infectious materials (e.g. bed linen, dressings, secretion and excretions).
• The skin of the patient should be disinfected before invasive procedures
• Emphasize HANDWASHING for personal hygiene
Basic Principles in Infection Control
Philippine Hospital Infection Control Society (PHICS), Inc.
Philippine Hospital Infection Control Society (PHICS), Inc.
Basic Principles in Infection Control
Rational Use of Devices
- Avoiding or removing factors that impair host defenses.
- Invasive devices should be avoided or should be removed as soon as possible
Philippine Hospital Infection Control Society (PHICS), Inc.
Basic Principles in Infection Control
Isolation Techniques based on method of spread
Protective or Reverse Isolation
Rationale: decreasing the contact of the immunocompromised host to potential pathogens
Immunotherapy, Immunizations and other methods of reconstituting patient’s immune response may be attempted
Philippine Hospital Infection Control Society (PHICS), Inc.
• The environment should be HOSTILE to the multiplication of pathogens, i.e. clean, dry, exposed to light and well ventilated.
• All infectious materials (e.g. linen, clinical waste, sharps) should be safely contained, decontaminated or destroyed.
Basic Principles in Infection Control
Philippine Hospital Infection Control Society (PHICS), Inc.
• All instruments and equipment should be clean and dry. Invasive items should be sterilized and items in contact with mucous membranes, body fluids and potentially infectious materials should be disinfected.
• Food should be hygienically
prepared, properly cooked and
stored at low temperatures until
used.
Basic Principles in Infection Control
Philippine Hospital Infection Control Society (PHICS), Inc.
• Susceptible patients or sites should be protected from pathogenic microorganisms: i.e. aseptic technique practice during wound dressing, or procedures
• Use of disposable supplies and equipment in an attempt to limit the spread of infection by this means
• Control of insects and rodents that serve as vectors in the spread of microorganisms
Basic Principles in Infection Control
Philippine Hospital Infection Control Society (PHICS), Inc.
SusceptibleSusceptibleHOSTHOST
Means ofMeans ofTransmissionTransmission
Hand HygieneEnvironmental CareWaste management
Disinfection and Sterilization
Hand HygieneRational use of Devices
IsolationImmunization,
ImmunotherapyProphylaxis
Breaking theChain of Infection
Hand HygieneAseptic Technique
practiceEnvironmental Care
Disinfection and Sterilization
AGENTAGENT
Philippine Hospital Infection Control Society (PHICS), Inc.
The Health Care Worker (HCW) should be aware of how infection is transmitted and the factors involved in the process
The HCW should be able to implement the MOST effective and applicable measures to prevent and control infection in his place of work
The HCW should have the proper attitude of infection control
Philippine Hospital Infection Control Society (PHICS), Inc.
Hospital Infection Control Hospital Infection Control CommitteeCommittee
Philippine Hospital Infection Control Society (PHICS), Inc.
Philippine Hospital Infection Control Society (PHICS), Inc.
Hospital Infection Control CommitteeHospital Infection Control Committee
Organizational Structure Under the office of the Medical Director
– Infection Control Team– Chairperson– Infection Control Physician– Infection Control Nurse– Reps from different clinical departments– Auxiliary members from Employee Health Service,
Engineering, Pharmacy, Central Sterilization and Supply Department and Housekeeping Department
Philippine Hospital Infection Control Society (PHICS), Inc.
Hospital Infection Control CommitteeHospital Infection Control Committee
Objective
To facilitate the effective
prevention,
detection, and
control
of healthcare associated infection among patients, healthcare workers and visitors.
Philippine Hospital Infection Control Society (PHICS), Inc.
Infection Control CommitteeInfection Control Committee
Responsibilities:
Formulates, updates, and implements infection
control policies and procedures:
- Hand hygiene
- Disinfection & sterilization
- Isolation policy
- Antibiotic Use
- Personnel Health
- Dietary- Linen & Laundry- Waste Management- Environmental Care
Philippine Hospital Infection Control Society (PHICS), Inc.
Infection Control CommitteeInfection Control Committee
Responsibilities:
Surveillance- nosocomial infection- antimicrobial resistance- proper infection control practice- personnel health- outbreaks- environment
Philippine Hospital Infection Control Society (PHICS), Inc.
Infection Control CommitteeInfection Control Committee
Training and education of healthcare staff
• Conducts orientation of new staff• Conducts activities for updates on infection
control for staff regularly• Disseminates necessary information
Philippine Hospital Infection Control Society (PHICS), Inc.
Organizational Structure; ICCOrganizational Structure; ICC
Medical DirectorICC----------------------------------
Nursing Service Medical Services Administrative
Philippine Hospital Infection Control Society (PHICS), Inc.
Membership of the Infection Membership of the Infection Control CommitteeControl Committee
Chairperson Infection control doctor Infection control nurse Representative from:
Administration Clinical departments (medicine, pediatrics, surgery,
obstetrics and gynecology, Infectious Disease Section) Microbiology laboratory Nursing service
Philippine Hospital Infection Control Society (PHICS), Inc.
Membership of the Infection Membership of the Infection Control CommitteeControl Committee
Representative from: Pharmacy Employee Health Service Central Sterilization and Supply Department Engineering Dietary Department Housekeeping Linen and laundry Waste Management
Philippine Hospital Infection Control Society (PHICS), Inc.
The Infection Control TeamThe Infection Control Team
IC PhysicianIC NurseMicrobiologistEpidemiologist
Philippine Hospital Infection Control Society (PHICS), Inc.
The Infection Control TeamThe Infection Control Team
An effective ICT:• Maintains direct access to a representative of the Hospital
Director/Administrator• Responsible to the ICC• Functions on a daily basis• Has access to appropriate facilities to enable it to perform
its duties• Have an efficient mechanism of reporting significant
hospital outbreaks
Philippine Hospital Infection Control Society (PHICS), Inc.
The Infection Control TeamThe Infection Control Team
Responsibilities• Educates, trains, and advises staff on all aspects
of infection control
• Conducts surveillance activities:• Nosocomial infections• Antibiotic resistance• Infection control practices
Philippine Hospital Infection Control Society (PHICS), Inc.
Establishing An Establishing An Infection Control ProgramInfection Control Program
• Identify interested and key hospital personnel as members of the ICC/ICT
• Accomplish a written description of the program (Infection Control Plan)• Goals, objectives, structure• Specific surveillance, prevention, control,
education, and training activities
Philippine Hospital Infection Control Society (PHICS), Inc.
Establishing An Establishing An Infection Control ProgramInfection Control Program
• Formulate written policies and procedures• study existing practices• modify existing policies as needed
• consider difficulties during implementation• after hospital-wide consultation• Implement changes gradually• Have the cooperation of the staff
Philippine Hospital Infection Control Society (PHICS), Inc.
Establishing An Establishing An Infection Control ProgramInfection Control Program
• Formulate written policies and procedures• simple, easy to follow, common sense• consider costs and availability of supplies• maintain standard of care• incorporate written policies in the IC manual• Monitor and evaluate periodically
Philippine Hospital Infection Control Society (PHICS), Inc.
Establishing An Establishing An Infection Control ProgramInfection Control Program
• Disseminate information • Implement and monitor• Annual evaluation on the IC program
• Assess the activities• Assess accomplishments • Identify any changes in goals, objectives,
structure• Assess the value of the program to the hospital
Philippine Hospital Infection Control Society (PHICS), Inc.
INFECTION CONTROL is…
Philippine Hospital Infection Control Society (PHICS), Inc.
Infection Control should be
..... a WAY of LIFE!
Philippine Hospital Infection Control Society (PHICS), Inc.
Thank You!