Aarti Sareen MSPT Honours I Roll No. 8HOSPITAL ACQUIRED INFECTIONS
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, 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
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
The hands are the most important vehicle 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 Techniques1. Alcohol hand rub2. Routine hand wash 10-15 seconds3. Aseptic procedures 1 minute4. Surgical wash 3-5 minutes
Routine Hand WashRepeat procedures until hands are clean
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 loopHealth care Surveillance centresystem ReportingEvent Data interpretation Analysis,Action Information Feedback, recommendations
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 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
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..
To control thenosocomialinfection we needto consider thechain of infectionand thetransmission of aninfectious agent
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)
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.
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
Isolation & barrier precautionsDecontamination of equipmentPrudent use of antibioticsHand washingDecontamination of environment The 5 pillars of infection control
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 Doctor (ICD) Infection Control Nurse (ICN)
Role of infection control teams • Education and training • Development and dissemination of infection control policy • Monitoring and audit of hygiene • Clinical audit