HOSPITAL ACQUIRED INFECTIONS

HOSPITAL ACQUIRED INFECTIONSAarti SareenMSPT Honours IRoll No. 8

Hospital acquired infection is also called Nosocomial infection or Healthcare-associated infections."nosus" = disease "komeion" = to take care of Nosocomial infections can be defined as infection acquired by the person in the hospital, manifestation of which may occur during hospitalization or after discharge from hospital. The person may be a patient, members of the hospital staff and/ or visitors.

EPIDEMIOLOGICAL INTERACTION

HOST FACTORS Suppresed immune system due to Age, Poor nutritional status, severity of underlying disease, complicated diagnostic & therapeutic procedure,therapeutic, THE AGENTVarieties of organismsInstitutional and human Reservoirs & their virulenceTHE ENVIRNOMNETEverything that surrounds the patient in the hospital is his environment.

Other patientsHospital staff and visitorsEatablesDust and other contaminated articles NCI

4

Endogenous/direct: Caused by the organisms that are present as part of normal flora of the patient

Exogenous/indirect Caused by organisms acquiring by exposure to hospital personnel, medical devices or hospital environment, cross-infection from medical personnel hospital environment- inanimate objectsair dust IV fluids & catheters washbowls bedpans endoscopes ventilators & respiratory equipment water, disinfectants etc

Source of infection

EXOGENOUS INFECTION SITES

6Because of the huge resistance iceberg (Figure 3), with as many as 5 to 10 patients colonized with resistant bacteria for every patient known to be infected, universal gloving may be a more preferable infection control strategy than contact precautions, which are applied only to the tip of the iceberg. With universal gloving, gowning of personnel is recommended only for self-protection, e.g., from blood and body fluid exposures.http://www.cdc.gov/ncidod/eid/vol7no2/weinstein.htm#Figure%203

The Inanimate Environment Can Facilitate Transmission

~ Contaminated surfaces increase cross-transmission ~

7

Exogenours Pathogens

Mid-1980sEnterobacteriaceaeS. aureusP. aeruginosaMid-1990sDecline in EnterobacteriaceaeIncrease in gram-positive cocciEmergence of fungiRecognition of virusesNosocomial Infections:Changing Microbiology

VirusesBacteriaFungiParasites

All microorganisms can cause nosocomial infections

Gram +veStaphylococcus aureusStaphylococcus epidermidisGram -veEnterobacteriaceae Pseudomonas aeruginosaAcinetobacter baumanniMycobacterium tuberculosisBACTERIA

COMMON BACTERIAL AGENTS(9%)(10%)(11%)(12%)(13%)(45%)

12

Viruses

Blood borne infections : HBV, HCV, HIVOthers: rubella, varicella, SARS

FungiCandida Aspergillus

Urinary tract infections (UTI)Surgical wound infections (SWI)Lower respiratory infectionsTraumatic wounds and burns infectionsPrimary bacteraemiaGastrointestinal tract Central nervous systemTYPES OF INFECTIONS

Major Types of Nosocomial Infections

Richards, MJ. 1999. Crit Care Med 27; 887.

Mode of trasmissionContact/hand borne (most common)

Aerial route or air borne Oral route

Parenteral route

Vector borne

Direct (physical contact)Hands & clothingDroplet contact followed by autoinoculationClinical equipment

Indirect via contaminated articles Bedpans, bowls, jugs, Instruments like needles, dressings,contaminated gloves,etc.

Contact (most common)

Airborne TransmissionDroplet respiratory secretions on surfacesInhalation of infectious particlese.g. (TB, Varicella)Oral routeParenteral routeVector borne: through mosquitoes, flies, rats

Pathogens transmission

The hands are the most importantvehicle of transmission of HCAI

20

Why Dont Staff Wash their Hands

(Compliance estimated at less than 50%)

21Hand out article and ask participants to get into small groups and select 5 most common reasons they do not was hands from the reasons listed in the article table 2 and list any other reasons they might think of in their own agencies.5 10 minutesDiscuss each groups list and collate list on white boardMark off those that repeat number list in order of most common (1) to least common (2)Ask for other reasons group have come up with list on board

Why Not?Skin irritationInaccessible hand washing facilitiesWearing glovesToo busyLack of appropriate staffBeing a physician(Improving Compliance with Hand Hygiene in Hospitals Didier Pittet. Infection Control and Hospital Epidemiology. Vol. 21 No. 6 Page 381)

Hand Hygiene TechniquesAlcohol hand rubRoutine hand wash 10-15 secondsAseptic procedures 1 minuteSurgical wash 3-5 minutes

23Routine hand wash10 15 seconds using a neutral pH soapBefore eating or smoking.After going to the toiletBefore significant patient contactBefore injection, venepunctureBefore and after routine use of glovesAfter handling items soiled with blood or body substancesAseptic proceduresOne minute using an antimicrobial soap or skin cleanserBefore any nonsurgical procedures that require aseptic technique (such as inserting IV catheters)Surgical washFirst wash 5 minutesSubsequent washes 3 minutes using an antimicrobial skin cleaner containing 4% chlorhexidine or povidone-iodineBefore any invasive surgical procedure

Non-water cleansers or antiseptic products such as alcohol-based hand rubs or foam may be used when hand washing facilities are inadequate or in emergency situations where there may be insufficient time and/or facilities.If hands are visibly soiled a source of water should be sought. Hands should be washed as soon as an appropriate facilities become available.Add Notes Here:

Repeat procedures until hands are cleanRoutine Hand Wash

24Note: Hand and wrist jewellery including plain weddings bands should not be worn, as these are likely to increase the presence of gram negative bacilliNails should be short and clean and artificial nails should be discouraged as they contribute to increased bacterial counts.Wet hands thoroughly with warm running water.Keep hands lower than elbows and apply soap.Use friction to clean between fingers, palms, backs of hands and wrists.4. Rinse hands under running water until all soap is gone. DO NOT TOUCH TAPS WITH CLEAN HANDS IF ELBOW OR FOOT CONTROLS ARE NOT AVAILABLE, USE PAPER TOWEL TO TURN TAPS OFF.5. Pat hands dry with a clean, single use towel. A neutral soap should be used for routine handwashing.If liquid soap is dispensed from reusable containers, these must be cleaned when empty and dried before refilling with fresh soap refilling soap containers is a potential source of infection. Where possible single use soap containers or bladders should be used.HANDWASH SOLUTIONS SHOULD NEVER BE TOPPED UPScrub brushes should not be used for routine handwashing because they can cause abrasion of the skin, and may be a source of infection.

Add Notes Here:

Areas Most Frequently Missed

HAHS 1999

Hand CareNailsRingsHand creamsCuts & abrasionsChappingSkin Problems

Hand hygiene is the simplest, most effective measure for preventing hospital-acquired infections.

Surveillance

Why surveillance?NCI cause of morbidity and mortalityOne third may be preventableSurveillance = key factor an infection control measureoverview of the burden and distribution of NCIallocate preventive resourcesSurveillance is cost-efficient!!

29

ObjectivesReducing infection ratesEstablishing endemic baseline ratesIdentifying outbreaksIdentifying risk factorsPersuading medical personnelEvaluate control measuresSatisfying regulatorsDocument quality of careCompare hospitals NCI rates

30

The surveillance loop

Event

Action

Data

Information

Health care systemSurveillance centreReportingFeedback, recommendationsAnalysis, interpretation

Considerations when creating a surveillance systemGoal of the surveillance system (why)Engage the stakeholders (who)Surveillance method (what, how, when)definitionwhat to collecthow to collect (operation of system)Available resources

32

WhoAll hospitals?All departments?All specialties?Other health institutions?

33

Stakeholders

34. = f.eks mikrobiologiske avdelinger, ulike sykehus innen et RHF, primrleger, poliklinikk

Tradisjon at FHI som fagorgan har kommunisert direkte med smittevernpersonell, med inforamsjon til ledelsenMed direktorat og departement

Ser behovet for, nytten av nrmere samarbeid med RHF- sentralt og nsker med dette mtet etablere et slikt samarbeid og ogs definere kommunikasjonslinjer

35

Control of NCI

There are three principal goals for hospital infection control and prevention programs:Protect the patientsProtect the health care workers, visitors, and others in the healthcare environment.Accomplish the previous two goals in a cost effective and cost efficient manner, whenever possible..Goals for infection control and hospital epidemiology

To control the nosocomial infection we need to consider the chain of infection and the transmission of an infectious agent

observance of aseptic technique frequent hand washing especially between patients careful handling, cleaning, and disinfection of fomites where possible use of single-use disposable items patient isolation avoidance where possible of medical procedures that can lead with high probability to nosocomial infection (urinary catheter)

Prevention & control of nosocomial infections

Various institutional methods such as air filtration within the hospitalAppropriate isolation precautions to protect patients, visitors, and HCWs.Surveillance for common infections, monitoring of high risk patients, and hospital area to identify outbreaks, document incidence and prevalence rate of specific infections and set goal for improvement.

Prevention & control of nosocomial infections (cont.)

Uttermost care should be taken in following services:House keepingDietary servicesLinen and laundryCentral sterile supply departmentNursing careWaste disposalAntibiotic policyHygiene and sanitation

The 5 pillars of infection control

Isolation & barrier precautionsDecontamination of equipmentPrudent use of antibioticsHand washingDecontamination of environment

Infection Control Committee

Infection control Committee (ICC): 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 TeamInfection Control Nurse (ICN)

Infection Control Doctor (ICD)

Role of infection control teamsEducation and trainingDevelopment and dissemination of infection control policyMonitoring and audit of hygieneClinical audit

Chart10.090.10.110.120.130.45

Sheet1Pseudomonas aeruginosa9%Enterococcus10%Coag-neg staphylococcl11%E-coli12%Staphylococcus aureus13%Other45%

Sheet1000000

Sheet2

Sheet3