Nosocomial infections/ HAI <ul><li>Nosocomial infections  are infections which are a result of treatment in a hospital or ...
Pathophysiology <ul><li>Within hours of admission, colonies of hospital strains of bacteria develop in the patient's skin,...
Pathophysiology <ul><li>Within hours of admission, colonies of hospital strains of bacteria develop in the patient's skin,...
Classification of Nosocomial Infections (based on) <ul><li>Source of micro-organisms </li></ul><ul><li>Type of infections ...
Source of micro-organisms <ul><li>Endogenous infections  </li></ul><ul><li>eg:  Klebsiella, E.coli </li></ul><ul><li>Exoge...
Type of infections <ul><li>Catheter related blood stream infections  (CR-BSI) </li></ul><ul><li>Urinary tract infections  ...
 
 
 
Agent related factors <ul><li>Virulence of the organism  (S.aureus, Pseudomonas). </li></ul><ul><li>Antimicrobial resistan...
Microbal Microbal agents: agents:  Bacteria  Viruses  Parasites  Fungus  MRSA/VRSA  VRE  MDR Acinetobacter  MDR  P...
Common bacterial nosocomial  infections causing bloodstream infections
Nosocomial UTI <ul><li>E. coli </li></ul><ul><li>Klebsiella </li></ul><ul><li>Pseudomonas </li></ul><ul><li>Entero cocci <...
Nosocomial Pneumonia <ul><li>Pseudomonas aeruginosa </li></ul><ul><li>Klebsiella spp </li></ul><ul><li>Staph aureus </li><...
Nosocomial SSI <ul><li>Staph aureus </li></ul><ul><li>Pseudomonads </li></ul><ul><li>CoNS </li></ul><ul><li>Gram negative ...
Nosocomial Viruses <ul><li>Hepatitis B & C </li></ul><ul><li>RSV </li></ul><ul><li>Rotavirus  </li></ul><ul><li>Enteroviru...
Nosocomial Parasite & Fungi <ul><li>Giardia lamblia </li></ul><ul><li>Cryptosporidium  </li></ul><ul><li>Sarcopties scabei...
 
 
 
Transmission of Nosocomial Infections Patient to patient Patient to  healthcare worker Healthcare worker  to patient
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Commonly used disinfectants <ul><li>Skin Disinfection (Antiseptic): </li></ul><ul><li>Isopropyl alcohol (70-80%) </li></ul...
Environmental Disinfection <ul><li>Clean surfaces </li></ul><ul><li>Ethyl alcohol (70%) is good for trolley top and thermo...
 
Isolation and containment  (in addition to Standard Universal Precautions)  Airborne precautions:  droplet  nuclei <5  µ ...
 
 
 
 
 
 
 
 
 
Training and capacity building  Training Methodology <ul><li>Combination of: </li></ul><ul><ul><li>Lectures </li></ul></ul...
 
 
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Hospital infection control

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Hospital infection control

  1. 2. Nosocomial infections/ HAI <ul><li>Nosocomial infections are infections which are a result of treatment in a hospital or a healthcare service unit, but secondary to the patient's original condition. </li></ul><ul><li>Infections are considered nosocomial if they first appear 48 hours or more after hospital admission or within 30 days after discharge. </li></ul>
  2. 3. Pathophysiology <ul><li>Within hours of admission, colonies of hospital strains of bacteria develop in the patient's skin, respiratory tract, and genitourinary tract. </li></ul><ul><li>Interaction between the contaminating organism and the host. </li></ul><ul><li>Not all colonized individuals develop infection . </li></ul><ul><li>Persons who have progressed from colonization to infection may represent only the “tip of iceberg” of persons carrying a particular pathogen. </li></ul>
  3. 4. Pathophysiology <ul><li>Within hours of admission, colonies of hospital strains of bacteria develop in the patient's skin, respiratory tract, and genitourinary tract. </li></ul><ul><li>Interaction between the contaminating organism and the host. </li></ul><ul><li>Not all colonized individuals develop infection . </li></ul><ul><li>Persons who have progressed from colonization to infection may represent only the “tip of iceberg” of persons carrying a particular pathogen. </li></ul>
  4. 5. Classification of Nosocomial Infections (based on) <ul><li>Source of micro-organisms </li></ul><ul><li>Type of infections </li></ul>
  5. 6. Source of micro-organisms <ul><li>Endogenous infections </li></ul><ul><li>eg: Klebsiella, E.coli </li></ul><ul><li>Exogenous infections </li></ul><ul><li>eg: Pseudomonas </li></ul>
  6. 7. Type of infections <ul><li>Catheter related blood stream infections (CR-BSI) </li></ul><ul><li>Urinary tract infections (UTI) </li></ul><ul><li>Ventilator related pneumonia (VAP) </li></ul><ul><li>Surgical site infections (SSI) </li></ul><ul><li>Burns infections </li></ul>
  7. 11. Agent related factors <ul><li>Virulence of the organism (S.aureus, Pseudomonas). </li></ul><ul><li>Antimicrobial resistance: highly influenced by usage patterns. </li></ul><ul><li>Resiliency: Ability to survive in the environment. </li></ul><ul><li>Resistance to disinfectants. </li></ul>
  8. 12. Microbal Microbal agents: agents:  Bacteria  Viruses  Parasites  Fungus  MRSA/VRSA  VRE  MDR Acinetobacter  MDR Pseudomonas  ESBL K. pneumo
  9. 13. Common bacterial nosocomial infections causing bloodstream infections
  10. 14. Nosocomial UTI <ul><li>E. coli </li></ul><ul><li>Klebsiella </li></ul><ul><li>Pseudomonas </li></ul><ul><li>Entero cocci </li></ul><ul><li>Candida albicans </li></ul>
  11. 15. Nosocomial Pneumonia <ul><li>Pseudomonas aeruginosa </li></ul><ul><li>Klebsiella spp </li></ul><ul><li>Staph aureus </li></ul><ul><li>Acinetobacter </li></ul><ul><li>Legionella </li></ul><ul><li>Aspergillus </li></ul><ul><li>Candida </li></ul><ul><li>Mycoplasma pneumoniae </li></ul><ul><li>Chlamydia pneumoniae </li></ul>
  12. 16. Nosocomial SSI <ul><li>Staph aureus </li></ul><ul><li>Pseudomonads </li></ul><ul><li>CoNS </li></ul><ul><li>Gram negative rods </li></ul><ul><li>Enterococci </li></ul>
  13. 17. Nosocomial Viruses <ul><li>Hepatitis B & C </li></ul><ul><li>RSV </li></ul><ul><li>Rotavirus </li></ul><ul><li>Enterovirus </li></ul><ul><li>CMV </li></ul><ul><li>HIV </li></ul><ul><li>Ebola </li></ul><ul><li>Influenza virus </li></ul><ul><li>HSV </li></ul><ul><li>VZV </li></ul>
  14. 18. Nosocomial Parasite & Fungi <ul><li>Giardia lamblia </li></ul><ul><li>Cryptosporidium </li></ul><ul><li>Sarcopties scabeii </li></ul><ul><li>Candida albicans </li></ul><ul><li>Aspergillus spp. </li></ul><ul><li>Cryptococcus neoformans </li></ul>
  15. 22. Transmission of Nosocomial Infections Patient to patient Patient to healthcare worker Healthcare worker to patient
  16. 42. Commonly used disinfectants <ul><li>Skin Disinfection (Antiseptic): </li></ul><ul><li>Isopropyl alcohol (70-80%) </li></ul><ul><li>Halogens (iodine, iodophores) </li></ul><ul><li>Quarternary ammonium compounds (cetrimide) </li></ul><ul><li>Biguanides (chlorhexidine) </li></ul><ul><li>Phenolics (hexachlorophene, choroxylenols like dettol) </li></ul><ul><li>Savlon (cetrimide + chlorhexidine) </li></ul><ul><li>  Heat sensitive instruments: </li></ul><ul><li>  Glutaraldehyde 2%, hydrogen peroxide 6% </li></ul>
  17. 43. Environmental Disinfection <ul><li>Clean surfaces </li></ul><ul><li>Ethyl alcohol (70%) is good for trolley top and thermometers. </li></ul><ul><li>Hypochlorite for surfaces with blood spills, viruses, food preparation surfaces. </li></ul><ul><li>Dirty surfaces </li></ul><ul><li>Phenolics (Lysol) </li></ul><ul><li>Sodium hypochlorite </li></ul><ul><li>  </li></ul>
  18. 45. Isolation and containment (in addition to Standard Universal Precautions)  Airborne precautions: droplet nuclei <5 µ m e.g.tuberculosis, chickenpox, measles requires negative air pressure room  Droplet precautions: droplet nuclei >5 µ m e.g. bacterial meningitis, diphtheria, respiratory syncytial virus  Contact precautions: enteric infections diarrhoea , skin lesions  Strict isolation: haemorrhagic fever, SARS
  19. 55. Training and capacity building Training Methodology <ul><li>Combination of: </li></ul><ul><ul><li>Lectures </li></ul></ul><ul><ul><li>Practical exercises </li></ul></ul><ul><ul><li>5 month course </li></ul></ul><ul><ul><li>Series of five 1-week courses </li></ul></ul><ul><ul><li>Practical application </li></ul></ul>
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