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HOSPITAL ACQUIRED
INFECTIONSDEPARTMENT OF COMMUNITY
MEDICINE
MODERATED BY: DR DHIRAJ SRIVASTAVA
PRESENTED BY: SANCHITA SAINIROLL NO.66
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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.
HOST FACTORS
THE AGENT
EPIDEMIO-
LOGICAL INTERAC
T-ION
ENVIRONMEN
T
SOURCES OF INFECTION
2 SOURCES :
EXOGENOUS• Outside the
human body
ENDOGENOUS• 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
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 :
o Multi resistant coagulase- negative Staphylococcus
o Candida spp.
MODES OF TRANSMISSION
ROUTES OF SPREAD
CONTACT AIR BORNE EXOGENOUS
CONTACT TRANSMISSION
(MOST COMMON MODE OF
TRANSMISSION)
CONTACT
DIRECT INDIRECT
HANDS,AUTOINOCULATION,EQUIPMENT.
BEDPANS,DRESSINGS,CONTAMINATED GLOVES
AIR BORNE TRANSMISSION
• DROPLET NUCLEI IN THE ATMOSPHERE
• RESPIRATORY SECRECTIONS ON SURFACE (FOMITES)
EXOGENOUS INFECTIONS SITES
IN HOSPITAL-INFECTIONS
STATUS IN INDIARISK OF INFECTION High in India.
• 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
PREVENTING NOSOCOMIAL INFECTIONS
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?
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
DUST CONTROL• Dust is released during SWEEPING, DUSTING
& BEDMAKING.
• Suppression by WET DUSTING VACUUM CLEANING
PROPER DISPOSAL OF HOSPITAL
WASTECOLOR 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,blades
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.
• LEVELS OF DISINFECTION:
o HIGH LEVEL - destroys all the microorganisms except heavy contamination by bacterial spores.
o INTERMEDIATE LEVEL – inactivates M.tuberculosis, vegetative bacteria, most viruses & fungi.
o LOW LEVEL – kills most bacteria, some viruses & some fungi.
STERILISATION• Operationally, defined as decrease in
microbial load to 10-4.
• Done for o Medical devices penetrating sterile body siteso Parenteral fluidso Medicationso 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.
ADMINISTRATIVE MEASURES
• Formation of a hospital “CONTROL OF INFECTION 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.
STANDARDS TO BE MAINTAINED
IN HOSPITAL
• 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 procedure(based on 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.
C.S.S.D• 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.
C.S.S.D OF UPRIMS&R, SAIFAI
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
• Bennett and Brachman’s Hospital Acquired Infections by William R. Jarvis
• Hospital Administration by Francis & de ’Souza
• Prevention of Hospital Acquired Infections WHO GUIDELINES
• CDC – www.cdc.gov/cdc.htm
• CSSD of UPRIMS&R, Saifai, Etawah – 206130
THANK YOU