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HOSPITAL ACQUIRED INFECTIONS
Aarti SareenMSPT Honours I
Roll 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 AGENT
Varieties of organisms
Institutional and human
Reservoirs & their virulence
THE ENVIRNOMNETEverything that surrounds the patient in the hospital is his environment.
Other patientsHospital staff and visitorsEatablesDust and other contaminated articles
NCI
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 objects– air – dust – IV fluids & catheters – washbowls – bedpans – endoscopes – ventilators & respiratory equipment – water, disinfectants etc
SOURCE OF INFECTION
EXOGENOUS INFECTION SITES
The Inanimate Environment Can Facilitate Transmission
~ Contaminated surfaces increase cross-transmission ~
Exogenours Pathogens
• Mid-1980’s– Enterobacteriaceae– S. aureus– P. aeruginosa
• Mid-1990’s– Decline in
Enterobacteriaceae– Increase in gram-
positive cocci– Emergence of fungi– Recognition of viruses
Nosocomial Infections:Changing Microbiology
VirusesBacteriaFungiParasites
All microorganisms can cause nosocomial infections
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%)
Viruses
◦ Blood borne infections : HBV, HCV, HIV◦ Others: rubella, varicella, SARS
Fungi◦ Candida ◦ Aspergillus
– Urinary tract infections (UTI)– Surgical wound infections (SWI)– Lower respiratory infections– Traumatic wounds and burns infections– Primary bacteraemia– Gastrointestinal tract – Central nervous system
TYPES OF INFECTIONS
Major Types of Nosocomial Infections
0
5
10
15
20
25
30
35
Overall ICU
UTIPneumoniaSWIBloodstreamOther
Richards, MJ. 1999. Crit Care Med 27; 887.
Mode of trasmission
Contact/hand borne (most common)
Aerial route or air borne Oral route
Parenteral route
Vector borne
Direct (physical contact)– Hands & clothing– Droplet contact followed
by autoinoculation– Clinical equipment
Indirect via contaminated articles– Bedpans, – bowls, jugs, – Instruments like needles, – dressings,– contaminated gloves,etc.
1. Contact (most common)
2. Airborne Transmission– Droplet respiratory secretions on surfaces– Inhalation of infectious particlese.g. (TB, Varicella)
3. Oral route4. Parenteral route5. Vector borne: through mosquitoes, flies,
rats
Pathogens transmission
The hands are the most importantvehicle of transmission of
HCAI
Why Don’t Staff Wash
their Hands(Compliance estimated at less than 50%)
Why Not?• Skin irritation• Inaccessible hand washing facilities• Wearing gloves• Too busy• Lack of appropriate staff• Being a physician
(“Improving Compliance with Hand Hygiene in Hospitals” Didier Pittet. Infection Control and Hospital Epidemiology. Vol. 21 No. 6 Page 381)
Hand Hygiene Techniques
1. Alcohol hand rub
2. Routine hand wash 10-15 seconds
3. Aseptic procedures 1 minute
4. Surgical wash 3-5 minutes
Repeat procedures until hands are clean
Routine Hand Wash
Areas Most Frequently Missed
HAHS © 1999
Hand Care• Nails• Rings• Hand creams• Cuts & abrasions• “Chapping”• Skin Problems
Hand hygiene is the simplest, most effective measure for preventing
hospital-acquired infections.
Surveillance
Why surveillance?
• NCI cause of morbidity and mortality• One third may be preventable• Surveillance = key factor
– an infection control measure– overview of the burden and distribution of NCI– allocate preventive resources
• Surveillance is cost-efficient!!
Objectives• Reducing infection rates• Establishing endemic baseline rates• Identifying outbreaks• Identifying risk factors• Persuading medical personnel• Evaluate control measures• Satisfying regulators• Document quality of care• Compare hospitals’ NCI rates
The surveillance loop
Event
Action
Data
Information
Health care system
Surveillance centre
Reporting
Feedback, recommendations
An
alysis, in
terpretatio
n
Considerations when creating a surveillance system
• Goal of the surveillance system (why)• Engage the stakeholders (who)• Surveillance method (what, how, when)
– definition– what to collect– how to collect (operation of system)
• Available resources
Who
• All hospitals?
• All departments?
• All specialties?
• Other health institutions?
Stakeholders
Control of NCI
There are three principal goals for hospital infection control and prevention programs:
1. Protect the patients
2. Protect the health care workers, visitors, and others in the healthcare environment.
3. 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 hospital
– Appropriate 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 keeping• Dietary services• Linen and laundry• Central sterile supply department• Nursing care• Waste disposal• Antibiotic policy• Hygiene and sanitation
The 5 pillars of infection controlIs
olati
on &
bar
rier p
reca
ution
s
Dec
onta
min
ation
of e
quip
men
t
Prud
ent u
se o
f anti
bioti
cs
Han
d w
ashi
ng
Dec
onta
min
ation
of e
nviro
nmen
t
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 Team
Infection Control Nurse (ICN)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