Hospital acquired infections


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Hospital acquired infections

  1. 1. Aarti Sareen MSPT Honours I Roll No. 8HOSPITAL ACQUIRED INFECTIONS
  2. 2. 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.
  3. 3. EPIDEMIOLOGICAL INTERACTION HOST FACTORS Suppresed immune system due to Age, Poor nutritional status, severity of underlying disease, complicated diagnostic & therapeutic procedure,therapeutic, NCI THE ENVIRNOMNET Everything that surrounds the patientTHE AGENT in the hospital is his environment.Varieties of organisms Other patientsInstitutional and human Hospital staff and visitors EatablesReservoirs & their virulence Dust and other contaminated articles
  4. 4. SOURCE OF INFECTION Exogenous/indirectEndogenous/direct: Caused by organisms acquiring by exposure to hospital personnel, medicalCaused by the devices or hospital environment, cross- infection from medical personnel organisms that are • hospital environment- inanimate objects present as part of – air normal flora of the – dust – IV fluids & catheters patient – washbowls – bedpans – endoscopes – ventilators & respiratory equipment – water, disinfectants etc
  6. 6. The Inanimate Environment Can Facilitate Transmission ~ Contaminated surfaces increase cross-transmission ~
  7. 7. ExogenoursPathogens
  8. 8. Nosocomial Infections: Changing Microbiology• Mid-1980’s • Mid-1990’s – Enterobacteriaceae – Decline in Enterobacteriaceae – S. aureus – Increase in gram- – P. aeruginosa positive cocci – Emergence of fungi – Recognition of viruses
  9. 9. All microorganisms can cause nosocomial infectionsVirusesBacteriaFungiParasites
  10. 10. BACTERIAGram +ve Staphylococcus aureus Staphylococcus epidermidisGram -ve Enterobacteriaceae Pseudomonas aeruginosa Acinetobacter baumanni Mycobacterium tuberculosis
  11. 11. COMMON BACTERIAL AGENTS Pseudomonas (9%) aeruginosa Enterococcus (10%) Coag-neg staphylococcl (11%) E-coli (12%) Staphylococcus aureus (13%) Other (45%)
  12. 12. Viruses◦ Blood borne infections : HBV, HCV, HIV◦ Others: rubella, varicella, SARSFungi◦ Candida◦ Aspergillus
  13. 13. TYPES OF INFECTIONS– Urinary tract infections (UTI)– Surgical wound infections (SWI)– Lower respiratory infections– Traumatic wounds and burns infections– Primary bacteraemia– Gastrointestinal tract– Central nervous system
  14. 14. Major Types of Nosocomial Infections353025 UTI20 Pneumonia15 SWI Bloodstream10 Other 5 0 Richards, MJ. 1999. Overall ICU Crit Care Med 27; 887.
  15. 15. Mode of trasmissionContact/hand borne (most common)Aerial route or air borneOral routeParenteral routeVector borne
  16. 16. 1. Contact (most common) Direct (physical contact) – Hands & clothing – Droplet contact followed by autoinoculation – Clinical equipmentIndirect via contaminated articles – Bedpans, – bowls, jugs, – Instruments like needles, – dressings, – contaminated gloves,etc.
  17. 17. 2. Airborne Transmission – Droplet respiratory secretions on surfaces – Inhalation of infectious particles e.g. (TB, Varicella)3. Oral route4. Parenteral route5. Vector borne: through mosquitoes, flies, rats
  18. 18. Pathogens transmission
  19. 19. The hands are the most important vehicle of transmission of HCAI
  20. 20. Why Don’t Staff Wash their Hands(Compliance estimated at less than 50%)
  21. 21. 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)
  22. 22. Hand Hygiene Techniques1. Alcohol hand rub2. Routine hand wash 10-15 seconds3. Aseptic procedures 1 minute4. Surgical wash 3-5 minutes
  23. 23. Routine Hand WashRepeat procedures until hands are clean
  24. 24. Areas Most Frequently Missed HAHS © 1999
  25. 25. Hand Care• Nails• Rings• Hand creams• Cuts & abrasions• “Chapping”• Skin Problems
  26. 26. Hand hygiene is thesimplest, most effectivemeasure for preventing hospital-acquired infections.
  27. 27. Surveillance
  28. 28. 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!!
  29. 29. 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
  30. 30. The surveillance loopHealth care Surveillance centresystem ReportingEvent Data interpretation Analysis,Action Information Feedback, recommendations
  31. 31. 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
  32. 32. Who• All hospitals?• All departments?• All specialties?• Other health institutions?
  33. 33. Stakeholders Central adm. Local ….. adm. Public Health ICP instituteI It-Directorat Surveillance of dep. surgical site infectionsMinistry SurgicalOf health wards Service Surgical dep. ward. 2 Lab Patients
  34. 34. Control of NCI
  35. 35. Goals for infection control and hospital epidemiologyThere are three principal goals for hospital infection control and prevention programs:1. Protect the patients2. 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..
  36. 36. To control thenosocomialinfection we needto consider thechain of infectionand thetransmission of aninfectious agent
  37. 37. Prevention & control of nosocomial infections– 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)
  38. 38. Prevention & control of nosocomial infections (cont.) – 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.
  39. 39. 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
  40. 40. Isolation & barrier precautionsDecontamination of equipmentPrudent use of antibioticsHand washingDecontamination of environment The 5 pillars of infection control
  41. 41. Infection Control Committee
  42. 42. 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.
  43. 43. Infection Control TeamInfection Control Doctor (ICD) Infection Control Nurse (ICN)
  44. 44. Role of infection control teams • Education and training • Development and dissemination of infection control policy • Monitoring and audit of hygiene • Clinical audit