HAI are a significant cause of increased morbidity and mortality in hospitalized patients. In addition, HAI lead to prolonged hospital stay, are inconvenient for the patients, and constitute huge economic burden on health care system. Studies have shown that HAI prevalence varies from 3.8% to 19.6% depending on the population surveyed with a pooled global prevalence of 10.1%.

1. 1
HEALTH CARE ASSOCIATED
INFECTIONS
BY DR SABA M MANSOOR
GUIDED BY DR HEMANT KUMAR
Department of Community Medicine,AJIMS &RC , Mangalore

2. 1. INTRODUCTION
2. HISTORY
3. DEFINITION
4. MAGNITUDE OFTHE PROBLEM
5. EPIDEMIOLOGICAL FACTORS
6. PREVENTION AND CONTROL OF HAIS
7. SURVEILLANCE
8. HAICC
9. UPDATE ON NEWERTECHNOLOGIES
10. SUMMARY
11. CONCLUSION
2

3. 3
The very first
requirement
in a hospital
is that it
should do
the sick no
harm
(Nightingale F 1859).

4. INTRODUCTION
4

5. Health Care-Associated
Infections (HCAI) were
earlier known as “Noso-
comial infections” and the
term was derived from
Greek words “nosus”
meaning disease and “
komeion” meaning to
take care of
HEALTH CARE-ASSOCIATED
INFECTIONS (HCAI)
5

6. Contd…
Health Care-Associated Infections
(HCAI) are acquired during hospital
care which are not present or
incubating at the time of hospital
admission.
HAI are a significant cause of
increased morbidity and mortality in
hospitalized patients. In addition, HAI
lead to prolonged hospital stay, are
inconvenient for the patients, and
constitute huge economic burden on
health care system.
6

7.  Studies have shown that HAI prevalence varies
from 3.8% to 19.6% depending on the population
surveyed with a pooled global prevalence of 10.1%.
 At any given time, out of every 100 hospitalized
patients, 7 in developed and 10 in developing
countries will acquire at least one health care-
associated infection.
 The fight against HCAI as a public health priority
was promoted through the World Health
Organization's 'Clean Care is Safer Care' campaign.
Source: BMC Proceedings 2011,Volume 5 Suppl 6http://www.biomedcentral.com
7

8.  HCAIs are multi-factorial, which are related to
healthcare systems and procedures as well as
behavioral practices.
 Although eradication of HAI is impossible, a well-
conducted prospective surveillance is the gold
standard and may significantly reduce HAI and
associated costs. However, this approach requires
comprehensive resources and well coordinated
prevention programs.
8

9. HISTORICAL PERSPECTIVES
OF
HOSPITAL ACQUIRED
INFECTIONS
9

10. 10

11.  Hippocrates made the relatively profound
statement “Primum non nocere” that is If you
wish to become a physician, always follow the
maxim, first do no harm.
 Nearer to the present day, Florence Nightingale
paraphrased Hippocrates’ words with the phrase
“It may seem a strange principle to enunciate as
the very first requirement in a hospital that it
should do the sick no harm”. (Nightingale F 1859)
11
http://www.apiindia.org/pdf/medicine_update_2012/infectious
disease_14.pdf

12.  In 1854, during the Crimean War she
demonstrated that hygiene could make a
difference. She demonstrated that cleaning up
the military hospital with fresh linens, rat
poisons and scrub–brushed floors would result
in a reduction of the combat wounded death
rates from 40% to 2% in a matter of six
months.
12http://www.apiindia.org/pdf/medicine_update_2012/infectious_disease_14.pdf

13. Contd..
At the same time Joseph Lister, a British
Surgeon also demonstrated that limb
amputations became infected 47% of the
time before hand washing and carbolic
acid antisepsis, and only 15% of the time
after this ritual was introduced.
13

14. HAI INTHE 20TH – 21ST CENTURY
 The present era of healthcare- associated infections
(HAI) started with the Center for Disease Control
and Prevention (CDC) in the USA. It started the
National Noso-comial Infection Surveillance System
(NNIS) in 1950s and the SENIC project in 1974.
 It was observed that one-third of healthcare-
associated infections were preventable through
effective infection control . Many guidelines were
produced by Healthcare Infection Control Practices
Advisory Committee (HICPAC).
14http://www.apiindia.org/pdf/medicine_update_2012/infectious_disease_14.pdf

15. Since 2005, various member countries of the
world have signed the pledge of WHO’s First
Global Patient Safety Challenge. Introducing low-
cost measures, such as hand hygiene, staff
education and inclusion of basic principles of
infection control in medical and paramedical
curricula can reduce health care associated
infections.
15

16. DEFINITION
16

17. DEFINITION
World Health Organization (WHO) defines
HCAI as:-
“An infection occurring in a patient during the
process of care in a hospital or other health-
care facility which was not present or
incubating at the time of admission. This
includes infections acquired in the hospital, but
appearing after discharge, and also occupational
infections among staff of the facility
www.who.int/bulletin/volumes/89/10/11-088179/en/
17

18. Contd..
These includes infections which are
Not present nor incubating at admission.
That appear more than 48 hours after
admission.
Those acquired in the hospital but appear
after discharge.
Occupational infections among staff as a
result of Needle Stick Injury / exposure to
blood & body fluids e.g. HBV, HCV & HIV.
18

19. The following conditions
are not infections
 Colonization, which means the presence of
microorganisms on skin, on mucous
membranes, in open wounds, or in
excretions or secretions but are not causing
adverse clinical signs or symptoms.
 Inflammation that results from tissue
response to injury or stimulation by
noninfectious agents, such as chemicals.
19

20. MAGNITUDE
OF
PROBLEM
20

21. DEVELOPED COUNTRIES
 In developed countries, even with sophisticated
treatments and technologies, HAI continues to
account for complications in 5-10% of admissions to
acute-care hospitals. HCAI pooled prevalence in
mixed patient populations in high-income countries:
7.6%.
 In the U.S. alone there are at least 80,000 fatalities
each year (about 200 deaths/day) from HAI. More
than 4 million patients affected by HCAI every year
in Europe .
 Approximately 30% of ICU patients are affected by at
least one episode of HCAI.
(WHO 2013)
21

22. Adults
1-3
3-5
5-10
>10
Number of national and multicentre studies reporting health
care-associated infection in high-income countries, 1995-2010
Lowest –France :4.4%
Highest – New Zealand :12.0%Source: Report on the burden of endemic health care-associated infection
worldwide.World Health Organization 2011 22
Neonates and
pediatrics
1-3
3-5
5-10
>10

23. DEVELOPING COUNTRIES
 In low- and middle-income countries the frequency of
ICU-acquired infection is at least 2─3 fold higher than in
high-income countries; device-associated infection
densities are up to 13 times higher than in the USA.
 The impact of HAI is far greater than developed
countries, the prevalence studies report hospital-wide
infection rates usually higher than 15%.
 In these countries, over 4000 children die of HAI every
day.
 Approximately half of all patients admitted to neonatal
intensive care units acquire an infection, and over half of
them die.
23
Source: Report on the burden of endemic health care-associated infection
worldwide.World Health Organization 2011

24. Number of studies* reporting health care-associated infection
in low- and middle-income countries,
1995-2010
Neonates and
pediatrics
1-3
3-5
5-10
>10
Adults
1-3
3-5
5-10
>10
Source: Report on the burden of endemic health care-associated infection
worldwide.World Health Organization 2011
Lowest – Mongolia : 5.4%
Highest – Albania : 19.1% 24

25. INDIAN SCENARIO
25

26. INCIDENCE
 Average Incidence - 10% to 30%, but may be still
higher in ICU
 Urinary Tract Infection - usually catheter related -
28%
 Surgical Site Infection or wound infection -19%
 Pneumonia -17%
 Blood Stream infection - 7% to 16%
26
https://www.google.co.in/?gfe_rd=cr&ei=sVdhVbf2LuXH8Afkj4GIDg&gwsr
d=ssl#q=EPIDEMIOLOGY+OF+NOSOCOMIAL+INFECTIONS+(NCI

27.  HAI control programme is at a nascent stage in
Indian hospitals, with some yet to establish a
central sterilization and supply department
(CSSD) and appoint an infection control team”
Suggestions to strengthen the infection control
programme is turned down by the management of
most hospitals as spending on infection control
does not generate revenue.”
27

28. What is the impact of health care-
associated infections?
 Annual financial losses due to health care-associated
infections are also significant: they are estimated at
approximately €7 billion in Europe, including direct
costs only and reflecting 16 million extra days of
hospital stay, and at about US$ 30 billion in the USA.
 In Mexican ICUs, the overall cost of one single health
care-associated infection episode was US$ 12 155. In
several ICUs in Argentina, the overall extra-cost
estimates for catheter-related bloodstream infection
and health care-associated pneumonia averaged US$ 4
888 and US$ 2 255 per case, respectively.
28
http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf

29. Contd……
 Antibiotic resistant infections due to
“Superbugs” are on the rise. One superbug,
called “MRSA,” affecting over 100,000 patients a
year, caused the death of more than 18,600
patients in 2010.
 This number supersedes the death rate for
breast cancer,AIDS and SARS combined.
29http://www.livescience.com/36674-superbugs-drug-resistant-bacteria-infections.html

30. PROLONGED HOSPITAL STAY
 Extra days:
Urinary tract infections : 06
Pneumonia : 12
Surgical site infections : 07
Blood Borne Infections : 14
30
https://www.google.co.in/?gfe_rd=cr&ei=sVdhVbf2LuXH8Afkj4GIDg&gwsr
d=ssl#q=EPIDEMIOLOGY+OF+NOSOCOMIAL+INFECTIONS+(NCI

31. RISK FACTORS FOR HAI
 Admission as an emergency and to the intensive care
unit (ICU);
 Hospital stay longer than seven days;
 Placement of a central venous catheter, indwelling
urinary catheter, or an endo-tracheal tube;
undergoing surgery;
 Patients on immuno-suppressants;
 Neutropenia; a rapidly or ultimately fatal disease and
impaired functional or coma status.
31

32. SETTINGS WITH LIMITED RESOURCES
• Inadequate environmental hygienic conditions
and waste disposal;
• poor infrastructure;
• insufficient equipment understaffing;
• overcrowding;
• poor knowledge and application of basic
infection control measures;
• lack of sophisticated procedures;
• lack of knowledge of injection and blood
transfusion safety;
• absence of local and national guidelines and
policies.
32

33. EPIDEMIOLOGICAL
FACTORS
33

34. • There are 3 main
factors related to
development of
HAIs
» Host factors
» Agent factors
» Environmental
factors
34

35. Host Factors
• Coma
• HIV infection
• Malignancies
• Diabetes mellitus
• Severe malnutrition
• Circulatory impairment
• Open wound or trauma
• Bronchopulmonary disease
35
 Advanced age or
premature birth
 severe burns and
certain skin diseases
 Chronic obstructive
pulmonary disease
 Immunodeficiency
(due to drug, or
irradiation)

36. AGENT FACTORS
Infectious agents may be from endogenous or
exogenous sources:
 Endogenous sources are body sites, such as the
skin, nose, mouth, gastrointestinal (GI) tract, or
vagina that are normally inhabited by
microorganisms.
 Exogenous sources are those external to the
patient, such as patient care personnel, visitors,
patient care equipment, medical devices, or the
healthcare environment.
36

37. Contd..
These may be broadly classified into the
following categories:
1. Conventional:- pathogens that could cause disease in
healthy persons in the absence of any specific
immunity to them.
2. Conditional:- pathogens that could cause disease
(other than simple localized infections) only in
persons with lowered resistance to infection or when
implanted directly into tissue or normally sterile area.
3. Opportunistic:- pathogens that could cause severe
disease only in patients with greatly diminished
resistance to infection
37
http://whqlibdoc.who.int/euro/es/EURO_SERIES_4.pdf

38. COMMON ORGANISMS
• Urinary tract infection: E. coli, enterococci, and
P. aeruginosa.
• Surgical wound infection: S. aureus,
enterococci and coagulase-negative
staphylococci.
• Bloodstream: coagulase-negative staphylococci,
S. aureus, enterococci, E. coli, and Candida spp.
• Lower respiratory tract infection: S. aureus. P.
aeruginosa and Enterobacter spp.
38

39. Contd..
• Among patients in the intensive care unit
(ICU) the commonest pathogens were:
 P. aeruginosa (12·4%).
 S. aureus (12·3%).
 coagulase-negative staphylococci (10·2%).
 Candida spp. (10·1%).
 Enterobacter spp. and enterococci (8·6% each).
39www.ncbi.nlm.nih.gov › NCBI › Literature › PubMed Central (PMC)

40. Contd..
There is the possibility of HAI transmission of
many viruses, including:
 The hepatitis B and C viruses (transfusions, dialysis,
injections, endoscopy).
 Respiratory syncytial virus (RSV), rotavirus, and
enteroviruses (transmitted by hand-to-mouth
contact and via the faecal-oral route).
 Other viruses such as cytomegalovirus, HIV, Ebola,
influenza viruses, herpes simplex virus, and varicella-
zoster virus, may also be transmitted.
40

41. COMMON SITES OF INFECTION
41www.ncbi.nlm.nih.gov › NCBI › Literature › PubMed Central (PMC)

42. Reservoir
Definition:
◦ Place in which an infectious agent can survive but may
or may not multiply
Common reservoirs:
 humans
 animals
 equipment/fomites
42

43. 43

44. Portal of Exit
The path by which an
infectious agent
leaves the reservoir
◦ Respiratory tract
◦ Genitourinary tract
◦ Gastrointestinal tract
◦ Skin/mucous
membrane
◦ Blood
◦ Transplacental
44

45. Portal of Entry
The path by which an infectious agent enters the
susceptible host
 Respiratory tract
 GU tract
 GI tract
 Skin/mucous membrane
 Parenteral
 Transplacental
45

46. MODES OFTRANSMISSION
There are five main modes of
transmission
Contact
Vector borne
Air borne
Droplet
Common vehicle
46

47. Contact Transmission
Direct contact
• person-to-person spread, actual
physical contact
Indirect contact
• contact with contaminated
intermediate object
47

48. Vector-borne Transmission
48
Vectors are small organisms such as
mosquitoes or ticks that can carry
pathogens from person to person and
place to place. Diseases like Malaria,
Dengue, Lymphatic Filariasis, Kala-azar,
Japanese Encephalitis and Chikungunya
are widely prevalent in India and can be
transmitted in poor hospital settings .

49. Airborne Transmission
Droplet nuclei, dust particles or
skin containing microorganisms
are transmitted to a susceptible
host by air currents
49
TB or not TB?

50. CommonVehicle Transmission
Microorganisms are transmitted
to susceptible hosts from
common items:
 Food
 Water
 Medications
 Devices/equipment
50

51. MAJOR TYPES OF HAIS
The four most common HAIs are :-
 Catheter-associated urinary tract infection
(CAUTI)
 Ventilator-associated pneumonia (VAP)
 Surgical site infection (SSI)
 Catheter related bloodstream infection (CR-BSI)
Each of these is associated with an invasive medical
device or invasive procedure
51

52. URINARYTRACT INFECTIONS
 Urinary tract infections (UTIs) are
commonest followed by SSI and pneumonia
 UTIs account for more than 15% of
infections reported by acute care hospitals.
Virtually all healthcare-associated UTIs are
caused by instrumentation of the urinary
tract.
 CAUTI can lead to such complications as
cystitis, pyelonephritis, gram-negative
bacteremia, prostatitis, epididymitis, and
orchitis in males and, less commonly,
endocarditis, vertebral osteomyelitis, septic
arthritis,endophthalmitis, and meningitis in
all patients.
52

53. SURGICAL SITE INFECTIONS
 SSIs were the most common healthcare-
associated infection, accounting for 10-13%
of all HAIs among hospitalized patients. with
a mortality rate of 3%, and 75% of SSI-
associated deaths are directly attributable to
the SSIs.
 While advances have been made in infection
control practices, including improved
operating room ventilation, sterilization
methods, barriers, surgical technique, and
availability of antimicrobial prophylaxis, SSIs
remain a substantial cause of morbidity,
prolonged hospitalization, and death.
53www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf

54. PNEUMONIA
Health care associated pneumonias are
the second most common type of
HAIs, second only to UTIs.
They are associated with a high rate
of mortality and morbidity. Patients
with mechanically-assisted ventilation
have a high risk of developing
healthcare-associated pneumonia.
Most commonly caused by
acinetobacter.
54www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf

55. BACTERAEMIA
Primary bloodstream infection (BSI) is a
leading, infectious complication among
critically ill patients. It represents about 6-9
% of all HAIs and affects approximately 1% of
all hospitalized patients.
The impact on patient outcome is
tremendous; BSI increases the mortality rate,
prolongs patient stay in an intensive care unit
(ICU) and in the hospital and generates
substantial extra costs.
55

56. PROBLEMS OF NOSOCOMIAL
INFECTIONS
 HAIs cause :-
 Increased suffering
 Prolonged hospital stay
 Increase the cost of care
significantly
 Increased morbidity and
Mortality.
 Extra financial burden on
Health system
56

57. PREVENTION
OF HAIs
57

58. GOALS FOR INFECTION CONTROL AND
HOSPITAL EPIDEMIOLOGY
There are three principal goals for HAI 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.
.
58

59. GENERAL MEASURES
59

60. Contd..
Assess the need for isolation.Screen all intensive
care unit (ICU) patients for the following:
◦ Neutropenia and immunological disorder
◦ Diarrhea
◦ Skin rashes
◦ Known communicable disease
◦ Known carriers of an epidemic strain of
bacterium.
60
ISOLATION
www.ijccm.org/article.asp?issn=0972-5229;year=2014;

61. IDENTIFY THETYPE OF ISOLATION NEEDED.
There are two types of isolation in the ICU
◦ Protective isolation for neutropenic or other
immunocompromised patients to reduce the
chances of acquiring opportunistic infections
◦ Source isolation of colonized or infected
patients to minimize potential transmission to
other patients or staff.
61

62. FOLLOW STANDARD PRECAUTIONS
Standard precautions include prudent preventive
measures to be used at all times, regardless of a
patient's infection status:-
Gloves
Sterile gloves should be worn after hand hygiene
procedure while touching mucous membrane
and non-intact skin and performing sterile
procedures e.g. arterial, central line and Foley
catheter insertion
62

63. Contd..
 Clean, non-sterile gloves are safe for touching blood,
other body fluids, contaminated items and any other
potentially infectious materials
 Change gloves between tasks and procedures in the
same patient especially when moving from a
contaminated body area to a clean body area.
 Never wear the same pair of gloves for the care of
more than one patient .
 Remove gloves after caring for a patient
 Practice hand hygiene whenever gloves are removed.
63

64. GOWN
 Wear a gown to prevent soiling of clothing
and skin during procedures that are likely to
generate splashes of blood, body fluids,
secretions or excretions.
 The sterile gown is required only for aseptic
procedures and for the rest, a clean, non-
sterile gown is sufficient .
 Remove the soiled gown as soon as possible,
with care to avoid contamination.
64

65. MASK, EYE PROTECTION/FACE SHIELD
 Wear a mask and adequate eye protection (eyeglasses
are not enough), or a face shield to protect mucous
membranes of the eyes, nose and mouth during
procedures and patient care activities that are likely to
generate splashes/sprays of blood and body fluids, etc.
 Patients, relatives and health care workers (HCWs)
presenting with respiratory symptoms should also use
masks (e.g. cough)
 Shoe and head coverings are not required in routine care
.
65

66. PATIENT-CARE EQUIPMENT
 Used patient-care equipment soiled with blood, body
fluids, secretions, or excretions should be handled
carefully to prevent skin and mucous membrane
exposures, contamination of clothing and transfer of
microorganisms to HCWs, other patients or the
environment .
 Ensure that reusable equipment is not used for the care
of another patient until it has been cleaned and sterilized
appropriately .
 Ensure that single use items and sharps are discarded
properly
66

67. Utmost care should be taken in
following services:-
1. House keeping
2. Dietary services
3. Linen and laundry
4. Central sterile supply department
5. Nursing care
6. Waste disposal
7. Antibiotic policy
8. Hygiene and sanitation
67

68. The 5 pillars of infection control
Isolation&barrierprecautions
Decontaminationofequipment
Prudentuseofantibiotics
Handwashing
Decontaminationofenvironment
68

69. CDC Recommendations to
Prevent Healthcare-Associated
Infections
69

70. To Prevent Catheter-Associated UrinaryTract
Infections (CAUTIs:)
70
1. Insert catheters only for appropriate indications
2. Leave catheters in place only as long as needed
3. Ensure that only properly trained persons insert and
maintain catheters
4. Insert catheters using aseptic technique and sterile
equipment (acute care setting)
5. Follow aseptic insertion, maintain a closed drainage
system
6. Maintain unobstructed urine flow
7. Comply with CDC hand hygiene recommendations
and Standard Precautions
http://www.cdc.gov/HAI/prevent/top-cdc-recs-
prevent-hai.html

71. To Prevent Surgical Site Infections (SSIs):
71
Before surgery
1. Administer antimicrobial prophylaxis in
accordance with evidence-based standards and
guidelines
2. Treat remote infections-whenever possible before
elective operations
3. Avoid hair removal at the operative site unless it
will interfere with the operation; do not use
razors
4. Use appropriate antiseptic agent and technique
for skin preparation

72. During Surgery /After Surgery
72
During Surgery
Keep OR doors closed during surgery except as
needed for passage of equipment, personnel, and
the patient
After Surgery
Maintain immediate postoperative normo thermia
Protect primary closure incisions with sterile
dressing
Control blood glucose level during the immediate
post-operative period (cardiac)
Discontinue antibiotics according to evidence-
based standards and guidelines

73. To Prevent Central Line-Associated Bloodstream
Infections (CLABSIs) Outside ICUs:
73
1. Remove unnecessary central lines
2. Follow proper insertion practices
3. Facilitate proper insertion practices
4. Comply with CDC hand hygiene recommendations
5. Use appropriate agent for skin antisepsis
6. Choose proper central line insertion sites
7. Perform adequate hub/access port disinfection
8. Provide staff education on central line maintenance
and insertion

74. To Prevent Clostridium difficile Infections
(CDI)
74
1. Contact Precautions for duration of diarrhea
2. Comply with CDC hand hygiene recommendations
3. Adequate cleaning and disinfection of equipment
and environment
4. Laboratory-based alert system for immediate
notification of positive test results
5. Educate about C. diff infection: healthcare personnel,
housekeeping, administration, patients, families

75. To Prevent MRSA Infections
75
1. Comply with CDC hand hygiene recommendations
2. Implement Contact Precautions for MRSA colonized
and infected patients
3. Recognize previously MRSA colonized and infected
patients
4. Rapidly report MRSA lab results
5. Provide MRSA education for healthcare providers.
Active surveillance testing – screening of patients to
detect colonization even if no evidence of infection
Other novel strategies
Decolonization
Chlorhexidine bathing

76. 76
WHO’S RESPONSE
WHO Patient Safety is actively working towards
establishing effective ways of improving global health care
and save lives lost to health care-associated infections.
Within WHO Patient Safety, the Clean Care is Safer Care
programme is aimed at reducing health care-associated
infections globally and works in collaboration with other
WHO programmes, and has placed improving hand hygiene
practices at the core of achieving this. by assisting with the
assessment, planning, and implementation of infection
prevention and control policies, and timely actions at
national and institutional levels.

77. 77

78. Hand Hygiene
Hands are the most
common vehicle to
transmit health care-
associated pathogens
Transmission of
health care-associated
pathogens from one
patient to another via
health-care workers’
hands requires
5 sequential steps

79. 5 stages of hand transmission
Germs present
on patient skin
and immediate
environment
surfaces
Germ transfer
onto health-care
worker’s hands
Germs survive
on hands for
several minutes
Suboptimal or
omitted hand
cleansing results
in hands
remaining
contaminated
Contaminated
hands transmit
germs via direct
contact with
patient or
patient’s
immediate
environment
one two three four five
79

80. The “My 5 Moments for Hand
Hygiene” approach
80
www.who.int/gpsc/5may/background/5moments/

81. To effectively reduce
the growth of germs
on hands,
handrubbing must
be performed by
following all of the
illustrated steps.
This takes only
20–30 seconds!
EIGHT STEPS FOR HANDWASH
81www.who.int/gpsc/5may/How_To_HandWash

82. How to handwash
To effectively
reduce the growth
of germs on hands,
handwashing
must last 40–60
secs
and should be
performed by
following all of the
illustrated steps
82

83. Hand hygiene and glove use
◦ The use of gloves does not replace the need to
clean your hands!
◦ You should remove gloves to perform hand
hygiene, when an indication occurs while wearing
gloves
◦ You should wear gloves only when indicated (see
the Pyramid in the Hand Hygiene Why, How and
When Brochure and in the Glove Use
Information Leaflet) – otherwise they become a
major risk for germ transmission
83

84. Compliance with hand hygiene
◦ Compliance with hand hygiene differs across
facilities and countries, but is globally <40%
◦ Main reasons for non-compliance reported by
health-care workers:
 Too busy
 Skin irritation
 Glove use
 Don’t think about it
84
www.who.int/gpsc/5may/slides_for_hand_hygiene

85. TIME CONSTRAINT
MAJOR OBSTACLE FOR HAND HYGIENE
Adequate handwashing with
water and soap requires
40–60 seconds
Average time usually
adopted by health-care
workers:
<10 seconds
85

86. WHO Multimodal Hand Hygiene
Improvement Strategy
 Based on the
evidence and
recommendations
from theWHO
Guidelines on
Hand Hygiene in
Health Care
(2009), a number
of components
make up an
effective
multimodal
strategy for hand
hygiene
ONE System change
Access to a safe, continuous water supply as well as
to soap and towels;readily accessible alcohol-based handrub
at the point of care
TWOTraining / Education
Providing regular training to all health-care workers
THREE Evaluation and feedback
Monitoring hand hygiene practices, infrastructure, perceptions
and knowledge,while providing results feedback to health-
care workers
FOUR Reminders in the workplace
Prompting and reminding health-care workers
FIVE Institutional safety climate
Creating an environment and the perceptions that facilitate
awareness-raising about patient safety issues
86www.who.int/gpsc/5may/Guide_to_Implementation.

87. Infection Control Committee
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88. Hospital Infection control
Committee (ICC):
The hospital HICC 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.
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Dr.Amitha Marla - Chairperson
Brig. (Dr.) Hemant Kumar - MD., Medical Superintendent, Conveyor - HIC
Dr.Anitha K.B., - Co ordinator - HICC Committee
Dr.Roopa Bhandary - HIC Officer - AJHRC
CLINICIANS:
Dr.Prashanth Marla - M.S., MCh (Urology)
Dr.SudeshRao - Intensivist&Anaesthologistof MICU
Dr.LathaSharma - HODDept of OBG
Dr.DevidasShetty - Deptof Surgery
Dr. Devan P.P. - ENT Dept.
Dr.SantoshT.Soans - HOD Dept of Paediatrics
Dr.Jayaram S. - Community Medicine
Dr.SiddharthPandith - Dental College
Dr. Mohandas Rai - Dept. of Pharmacology
Mrs.Juliet -Nursing Supervisor
Mrs.Sangeetha - NABH nursing Co-ordinator
Mrs.Prinita - HIC Nurse
Mrs. Melanie Lewis - HIC Nurse
All ICUs - All ICU Incharges
Nursing College - Principal
Mr. Harish S.P. - Pharmacy Incharge
Mr.Anand - Housekeeping Incharge
Mrs.Niramala Kumari - Quality Control Department
AJIMS/AJHRC Hospital Infection control Committee (ICC):

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RESPONSIBILITIES OF THE HIC
COMMITTEE
1. To develop policies for the prevention and control
of infection and to oversee the implementation of
the infection control programme.
2. Be composed of representatives of various units
within the hospital that have roles to play
(medical, nursing, engineering, housekeeping,
administrative, pharmacy, sterilizing service and
microbiology departments)
3. Elects one person of the committee as the
chairperson (who should have direct access to
the head of the hospital administration)

91. Contd…
4. Appoint an infection control practitioner (health
care worker trained in the principles and
practices of infection control, e.g. a physician,
microbiologist or registered nurse) as
secretary.
5. Meet regularly every 2nd Tuesday (ideally
monthly but not less than three times a year).
6. Develop its own infection control manual/s; and
Monitor and evaluate the performance of the
infection control programme
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92. CHALLENGES IN HAI CONTROL
92
1. Increasing emerging infections
2. Increasing resistant organisms
3. Increasing drug costs
4. Institute of Medicine Report--healthcare-
associated infections
5. Nursing shortage
6. Multiple benchmark systems.
7. FDA legislation on reuse of single-use devices

93. CHANGING DEMANDS ON INFECTION
CONTROL PROGRAMME
93
Today's ICP needs knowledge of
epidemiology statistics, patient
care Practices, occupational
health, sterilization, disinfection,
and sanitation, infectious
diseases, microbiology, education
and management

94. Infection Control Committee and Antibiotic
Policies are Back bone for reduction of
Infections
94

95. SURVEILLANCE
95
The key to ongoing monitoring is
surveillance for HAI . Various
techniques for surveillance have
been described and evaluated
including total house
Surveillance or targeted
Surveillance.

96. OBJECTIVES OF SURVEILLANCE
1. Identifying risk factors
2. Reducing infection rates
3. Establishing baseline rates
4. Identifying outbreaks
5. Persuading medical personnel
6. Evaluate control measures
7. Documentation
8. Compare hospitals’ HAI .
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98. LIGHT TECHNOLOGY TO COMBAT
HOSPITAL INFECTIONS
98
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.

99. Contd…..
99
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.

100. MEDICAL DRESSING USES
NANOTECHNOLOGY TO FIGHT INFECTION
100
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

101. NEW BANDAGES CHANGE COLOR IF
INFECTIONS ARISE
101
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.

102. New Nanotechnology for Hospital Infection
Control Receives FDA Approval
102
Silva Gard 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,
Silva Gard is expected to
have a significant impact on
the battle against hospital-
related infections.

103. SUMMARY
1. Identifying local determinants of the HAI
burden.
2. Improving reporting and surveillance systems
at the national level.
3. Ensuring minimum requirements in terms of
facilities and dedicated resources available for
HAI surveillance at the institutional level,
including microbiology laboratories’ capacity.
4. Ensuring that core components for infection
control are in place at the national and
health-care setting levels.
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104. CONTD…
5. Implementing standard precautions,
particularly best hand hygiene practices at the
bedside.
6. Improving staff education and accountability.
7. Conducting research to adapt and validate
surveillance protocols based on the reality of
developing countries.
8. Conducting research on the potential
involvement of patients and their families in
HAI reporting and control.
104

105. TAKE HOME MESSAGE
1. HCAI places a serious disease burden and significant
economic impact on patients and health-care
systems
2. Good hand hygiene – the simple task of cleaning
hands at the right times and in the right way – saves
lives
3. There are 5 Moments for Hand Hygiene in Health
Care
4. Global compliance with the My 5 Moments for
Hand Hygiene approach is universally sub-optimal .
5. Community support and compliance with WHO
initiatives is essential to save lives in our health care
facility
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107. REFERENCES
1. Park's Textbook of Preventive and Social Medicine - 2013.
2. Community Medicine with Recent Advances – 2014 by AH Suryakantha .
3. WHO. 2011Clean Care is Safer Care. Report on the Burden of Endemic
Health Care-Associated Infection Worldwide.
4. WHO-2014. Hand Hygiene: Why, How & When?
5. WHO-2004.Practical Guidelines for Infection Control in Health Care Facilities.
SEARO Regional Publicación No. 41.
6. World Health Organization – 2002. Prevention of hospital-acquired Infections
A PRACTICAL GUIDE 2nd edition.
7. WHO Global Strategy for Containment of Antimicrobial Resistance 2001.
8. Control of Health-Care--Associated Infections, 1961—2011. Richard E Dixon,
MD Health Net of California, Rancho Cordova, California.. http://www.
cdc.gov/mmwr/preview/mmwrhtml/su6004a10.htm. Accessed on 21May 2015.
9. Prevention of health-care-associated infections (HAI) and antimicrobial
resistance (AMR) in Europe.
10. The NWT Infection Prevention and Control Manual. March 2012.
11. INFECTION PREVENTION & CONTROL Best Practice . Infection Prevention
& Control Reference Guide October 1, 2013
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108. 12. T.D. Chugh, New Delhi.HOSPITAL INFECTION CONTROL – ARE WE
SERIOUS? Medicine Update 2012 .Vol. 22.
13. The DirecT MeDical cosTs of Healthcare-Associated Infections in U.S.
Hospitals and the Benefits of Prevention . R. Douglas Scott II, Economist
Division of Healthcare Quality Promotion National Center for Preparedness,
Detection, and Control of Infectious Diseases Coordinating Center for
Infectious Diseases Centers for Disease Control and Prevention March
2009.
14. WHO. Health care-associated infections. 2014.FACT SHEET .
15. Bat Erdene Ider, Jon Adams, Anthony Morton, Michael Whitby and Archie
Clements. Perceptions of healthcare professionals regarding the main
challenges and barriers to effective hospital infection control in Mongolia: a
qualitative study. BMC Infectious
Diseases 2012, 12:170 doi:10.1186/1471-2334-12-170
16. Pittet D: Infection control and quality health care in the new millenium.Am J
Infect Control 2005, 33:258-267.
17. HOSPITAL INFECTION PREVENTION AND CONTROL MANUAL. AJ
HOSPITAL & RESEARCH CENTRE. Review Date: February 2015.
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109. Contd..
18. Mehta Y, Gupta A, Todi S, Myatra S N, Samaddar D P, Patil V,
Bhattacharya PK, Ramasubban S. Guidelines for prevention of hospital
acquired infections. Indian J Crit Care Med 2014;18:149-63.
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