Dr.T.V.Rao MD

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A Tribute to Ignaz Semmelweiss (1818-1865)

Ignaz Semmelweiss (1818-1865)� Obstetrician, practised in

Vienna� Studied puerperal (childbed)

fever� Established that high maternal

mortality was due to failure of doctors to wash hands after post-mortems

� Reduced maternal mortality by 90%

� Ignored and ridiculed by colleagues

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What is Hospital Acquired Infections

�Any infection that is not present or incubating at the time the patient is admitted to the hospital

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�Additional morbidity

�Prolonged hospitalization

�Long-term physical, developmental and neurological sequelae

� Increased cost of hospitalization

� Death

Consequences of Hospital Acquired Infections

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Why Everyone Concerned with Hospital Infections

� The Centers for Disease Control (CDC) estimates that 2 million U.S. patients a year acquire hospital-related infections. These infections cost an average of $47,000 per patient to treat and cause 90,000 deaths each year. The added cost to hospitals is $4.8 billion annually in extended care and treatment.

�� Infection control is the discipline concerned with

preventing nosocomial or healthcare-associated infection. As such, it is a practical (rather than an academic) sub-discipline of epidemiology. It is an essential (though often under-recognized and under-supported) part of the infrastructure of health care. Infection control and hospital epidemiology are akin to public health practice, practiced within the confines of a particular health-care delivery system rather than directed at society as a whole.

What is Infection Control

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�� Infection control addresses factors related to the spread of

infections within the health-care setting (whether patient-to-patient, from patients to staff and from staff to patients, or among-staff), including prevention (via hand hygiene/hand washing, cleaning/disinfection/sterilization, vaccination, surveillance), monitoring/investigation of demonstrated or suspected spread of infection within a particular health-care setting (surveillance and outbreak investigation), and management (interruption of outbreaks).

Infection Control is Complex programme

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Beginning of Hospital Infection Programme

� Modern hospital infection control programs first began in the 1950s in England, where the primary focus of these programs was to prevent and control hospital-acquired staphylococcal outbreaks. In 1968, the American Hospital Association published "Infection Control in the Hospital," the first and only standards available for many years.

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Centre For Disease Control and Prevention

�The Communicable Disease Center, later to be renamed the Centers for Disease Control and Prevention (CDC), began the first training courses specifically about infection control and surveillance.

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CDC Initiates Hospital Infection Branch

� In 1972, the Hospital Infections Branch at the CDC was formed and the Association for Practitioners in Infection Control was organized. By the close of the decade, the first CDC guidelines were written to answer frequently asked questions and establish consistent practice.

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First Data on Infection Control Efficacy

� In 1985, the Study of the Efficacy of Nosocomial Infection Control (SENIC) project was published, validating the cost-benefit of infection control programs. Data collected in 1970 and 1976-1977 suggested that one-third of all nosocomial infections could be prevented

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Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

� In 1969, the Joint Commission for Accreditation of Hospitals--later to become the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)--first required hospitals to have organized infection control committees and isolation facilities

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CDC formulates Guidelines on Infection Control

� In 1972, the Hospital Infections Branch at the CDC was formed and the Association for Practitioners in Infection Control was organized. By the close of the decade, the first CDC guidelines were written to answer frequently asked questions and establish consistent practice.

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Break the Chain of Infections

� 1. Organisms that can cause infection are subject to risk assessment under the COSHH regulations and Management of Health and Safety at Work Regulation 1992.

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�� Various substances such as disinfectants used to prevent cross

infection are subject to risk assessment prior to use. Health and Safety guidance highlights the importance of the risk assessment process i.e. Identify the risk

� Assess the risk

� Note current measures which are being used to control or mitigate the risk

� Inform/train staff

� Monitor outcomes

� Implement policies and procedures

Risk assessment of Substances in use for ICP

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Beginning of AIDS Pandemic Necceciates Stronger Infection Control Protocols

� The second and certainly most significant factor influencing infection control at the time was the advent of acquired immunodeficiency syndrome (AIDS). The human immunodeficiency virus (HIV) has taken an enormous toll in terms of loss of life and productivity. For infection control professionals (ICPs), HIV has been a challenge for education, risk reduction and resource utilization.

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�� Study of the Efficacy of Nosocomial Infection Control (SENIC)

project was published, validating the cost-benefit of infection control programs. Data collected in 1970 and 1976-1977 suggested that one-third of all nosocomial infections could be prevented if all the following were present:

� One infection control professional (ICP) for every 250 beds. � An effective infection control physician. � A program reporting infection rates back to the surgeon and

those clinically involved with the infection. � An organized hospital-wide surveillance system.

Study of the Efficacy of Nosocomial Infection Control (SENIC) project

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�� Decreasing reimbursement

� Increasing emerging infections

� Increasing resistant organisms

� Increasing drug costs

� Institute of Medicine Report--healthcare-associated infections

� Nursing shortage

� OSHA safety legislation

� Multiple benchmark systems

� FDA legislation on reuse of single-use devices

Infection Control Challenges of

Healthcare in 2000

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�� Infection control programs had to encompass not only

hospitals but also the long-term care facility, home health/hospice, rehabilitation facilities, free-standing surgical centers, and physician office practices. A dramatic shift in patient care practices occurred as greater than 65% of surgery cases were operated on in an outpatient setting. Issues that will continue to impact infection control programs into the new millennium are a challenging combination of cost and clinical factors and increasing cost to treat infections, and financial impact of implementing new government regulations .

Infection control was influenced by the reform of the Healthcare System

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Changing Demands on Infection Control programme

� Today's ICP needs knowledge of epidemiology statistics, patient care practices, occupational health, sterilization, disinfection, and sanitation, infectious diseases, microbiology, education and management

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Infection Control Committee and Antibiotic Policies are Back bone for reduction of Infections

�� The major responsibilities for ICPs to oversee include

surveillance, specific environmental monitoring, continuous quality improvement, consultation, committee involvement, outbreak and isolation management, regulatory compliance and education. To plan, coordinate, and succeed in fulfilling these responsibilities, many ICPs have to redefine their roles. More ICPs are becoming managers by creating multidisciplinary support teams to carry out many of the functions.

Major Responsibilities of I C P

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GUIDELINES AND RECOMMENDATIONS

�Hand washing and Hospital Environmental Control * Immunization * Infectious Diseases Control * Intravascular Device-Related Infections and its control * Isolation Precautions

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Good House Keeping a Boon to Infection Control

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Scientific Disinfection Practices Saves Several Lives

� *Long-Term Care Facilities *Guidelines for Infection Control in Health Care Personnel * Surgical Site Infections Control * Urinary Tract and Respiratory Tract Infections Control * Ordering and Preparing Guidelines appropriately

� * Home care � * Hospital Construction � * Sterilization / Disinfection

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Surveillance

� The key to ongoing monitoring is surveillance for nosocomial infections. Various techniques for surveillance have been described and evaluated including total house surveillance, targeted surveillance, Kardex, or laboratory-base

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Computerized Surveillance

� Surveillance traditionally involved significant manual data assessment Increasingly, integrated computerized software solutions are becoming available that assess incoming risk messages from microbiology and other online sources. By reducing the need for data entry, this software significantly reduces the data workload of ICPs, freeing them to concentrate on clinical surveillance.

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Infection Control programme is Hospital Oriented

� ICPs should evaluate their institutional needs and develop a surveillance plan to present to the infection control committee on a yearly basis. Choosing one or two specific surveillance problems and setting a goal for reduction will focus the efforts of the ICP. JCAHO requires documenting the rationale for selecting a specific surveillance approach

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Outbreak Investigations

� Unlike scheduled activities, occasional clusters of patients who are colonized or infected will trigger further investigation including a case-control study. New laboratory methods developed and refined within the last decade can now determine how related the strain is at the molecular level.

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Infection Control Programme Integrated with Health Authorities

� The institution usually makes the infection control program responsible for reporting communicable diseases required by state law. ICPs need to plan on interacting with local and state health departments regarding exposure that may need immediate community follow-up (e.g., tuberculosis, Cholera). ICPs should assist the health department in confirming cases that may have been seen in the hospital or clinic.

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�� Every infection control program should develop a well-

defined written plan outlining the organizational philosophy regarding infection prevention and control. The plan should take into account the goals, mission statement, and an assessment of the infection control program. It should include a statement of authority, and should review patient demographics including geographic locations of patients served by the healthcare system

Formulating an Infection Control Plan

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Staff Training in ICP� Education programs for employees

and volunteers are one method to ensure competent infection control practices. It is a unique challenge since employees represent a wide range of expertise and educational background. The ICP must become knowledgeable in adult education principles and use educational tools and techniques that will motivate and sustain behavioral change.

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Infection Control Programme and Documentation

�Goals of the infection control program need to be incorporated into the mission statement of the facility. A mission statement should tell who you are, what you do, and should communicate a clear view of purpose and set a strategy for accomplishing the goal

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Document Antibiograms with WHONET

�WHONET is a free Windows-based database software developed for the management and analysis of microbiology laboratory data with a special focus on the analysis of antimicrobial susceptibility test results.

�� CDC with the Hospital Infection Control Practices Advisory

Committee (HICPAC) has produced or revised several major guidelines in the past two years including, Guidelines for Infection Control in Healthcare Personnel, and Guidelines for Management of Healthcare Worker Exposures to HIV and Recommendations for Post exposure Prophylaxis, Guidelines for Prevention of Surgical Site Infections. APIC has developed several guidelines covering topics including antisepsis and hand washing, disinfection and sterilization, endoscopy, and long-term care.

CDC Guides the Medical profession ICP

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Health Care Means In patient care and outpatient care

� Significant trends in healthcare are occurring everyday including new medical procedures (i.e., gene therapy), new technology (multi-purpose intravenous catheters), and a shift from inpatient to outpatient care.

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Light technology to combat Hospital Infections

� A pioneering lighting system that can kill hospital superbugs – including MRSA and C.diff –has been developed by researchers at the University of Strathclyde in Glasgow, Scotland. The technology decontaminates the air and exposed surfaces by bathing them in a narrow spectrum of visible-light wavelengths, known as HINS-light.

�� The technology decontaminates the air and exposed

surfaces by bathing them in a narrow spectrum of visible-light wavelengths, known as HINS-light.

�Clinical trials at Glasgow Royal Infirmary have shown that the HINS-light Environmental Decontamination System provides significantly greater reductions of bacterial pathogens in the hospital environment than can be achieved by cleaning and disinfection alone, providing a huge step forward in hospitals' ability to prevent the spread of infection.

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Light technology to combat hospital infections

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Light Technology to Combat Hospital Infections

� HINS-light is a safe treatment that can be easily automated to provide continuous disinfection of wards and other areas of the clinical environment. The pervasive nature of light permits the treatment of air and all visible surfaces, regardless of accessibility, either through direct or reflected exposure to HINS-light within the treated environment

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Medical Dressing Uses Nanotechnology to Fight Infection

� Scientists at the University of Bath and the burns team at the Southwest UK Pediatric Burns Centre at Frenchay Hospital in Bristol are working together with teams across Europe and Australia to create an advanced wound dressing.

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New Bandages Change Color If Infections Arise

�The dressing will work by releasing antibiotics from Nano capsules triggered by the presence of disease-causing pathogenic bacteria, which will target treatment before the infection takes hold.

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New Nanotechnology for Hospital Infection Control Receives FDA Approval

� SilvaGard can be used to treat virtually any medical device and its use does not alter the device's original properties. Due to these and other unique attributes, SilvaGard is expected to have a significant impact on the battle against hospital-related infections.

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Long Sleeves x Short Sleeves

� Results from a study by Denver

Health and University of Colorado Health Services Center researchers showed there were no statistically significant differences found in bacterial or MRSA counts between physicians’ coats and newly laundered short-sleeved uniforms.The researchers’ findings sheds new light on British government agencies’ policies banning physicians’ white coats based on the belief that long sleeves carry more bacteria and pose a greater risk of bacterial transmission

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. Vision-based hand gesture recognition Technology

� The technology relies on hand gestures as commands, which can control robotic nurses or tell computers to display pertinent patient health information, Juan Pablo Wachs, assistant professor of industrial engineering at Purdue University works and popularises.The vision-based hand gesture recognition technology could also be used for the coordination of emergency response activities during disasters.

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Involvement of Physicians More Important

Physicians to be more involved and lead quality improvement efforts in their respective healthcare settings. Drs. Pronovost and Marsteller suggest that even though quality improvement efforts exist, there is not enough data supporting the notion that quality improvement efforts are actually enhancing patient outcomes. One of the reasons for this lack of progress, they say, is inadequate physician engagement and leadership in quality improvement work.Peter Pronovost, MD, PhD, and Jill Marsteller, PhD, MP

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Scientific Documentation Reduces Hospital Infections

� Researchers evaluated the effect of an electronic medical record on the use of antimicrobial agents and infection rates of Clostridium difficile and MRSA. Results showed that implementation of an EMR significantly increased chart reviews and antimicrobial recommendations, leading to a decrease in antimicrobial use and MRSA as well as C. difficile infection rates.

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Impact of Hand Washing on Influenza

� Health experts believe a flu epidemic was averted last year because of regular hand-washing, suggesting healthcare facilities should promote hand-washing among staff and patients to prevent the spread of disease. The American Society for Microbiology and the American Cleaning Institute released a study in Sept. 2010 reporting that 85 percent of people washed their hands in public restrooms in 2008, the highest levels observed since the research began in 1996.Dr.T.V.Rao MD 49

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Hand Hygiene Compliance

� Researchers have implemented a hand hygiene program driven by a behavioral change approach to increase hand hygiene compliance. The hand hygiene program was packaged with several initiatives. It included access to alcohol sanitizer, education as well as ongoing audit and feedback. The program was also supplemented with behavior modification practices, such as immediate positive reinforcement as well as annually changing incentives. The researchers report the program has resulted in significant and sustained improvements in hand hygiene compliance.

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Which Skin Preparation Agent is Superior

� Researchers conducted a review of surgical skin prep agents to conclude which agent was most cost-effective and superior in preventing surgical site infections. Based on information collected from two databases, researchers compared povidone-iodine, Chlorhexidine gluconate, parachoroxylenol and iodine povacrylex (0.7 percent available iodine) in 74 percent isopropyl alcohol (DuraPrep). Researchers concluded that each prep agent has specific advantages and disadvantages and no one skin prep agent is superior in all clinical situations. Factors to consider when choosing a skin prep agent include surgeon preference and environmental risks.

�� Health care workers may be exposed to certain infections in the

course of their work. Vaccines are available to provide some protection to workers in a healthcare setting. Depending on regulation, recommendation, the specific work function, or personal preference, healthcare workers or first responders may receive vaccinations for hepatitis B; influenza measles, mumps and rubella; Tetanus, diphtheria, pertussis; N. meningitides; and varicella.

� The problem of resources for proving Vaccines in Developing countries continues to be real problem, need additional economic resources

Health Care Workers are at Risk –Need for Vaccination

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Become a Member of Alliance for the Prudent Use of Antibiotics (APUA)

www.apua.org

�An international organization dedicated to curbing antibiotic resistance

�Chapters exist currently in several Asian countries: Australia, China, India, Nepal, Pakistan, Philippines, South Korea, Taiwan, Vietnam

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��Created by Dr.T.V.Rao MD for ‘e ‘ learning

resources for Infection Control Personal in the Developing World

� Email

� doctortvrao@gmail.com

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