Nosocomial infections


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  • These are not nosocomial infections: Infections contracted and developing outside hospitals, which require admission Infections contracted outside hospital which become clinically apparent when patient is in hospital
  • Whether you work in a traditional hospital setting, ambulatory clinic, nursing home, rehabilitation center, free-standing dialysis center or any kind of facility in between, nosocomial infections will present themselves and demand your attention. Think of yourself as the "conductor," overseeing the well-being of patients, employees, physicians, auxiliary healthcare workers, volunteers and visitors. 10 As conductor, you must determine not only when a nosocomial event occurs, but when to investigate, tabulate, intervene and assess again.
  • Most infections acquired in hospital are caused by micro-organisms that are commonly present in the general population in whom they cause disease less often and usually in a milder form than in hospital patients. Thus, contact with microorganisms is seldom the sole or main event predisposing to infection Various risk factors, alone or in combination, influence the frequency and nature of hospital infection
  • Small droplets evaporate to droplet nuclei within 5ft from the mouth; large droplets settle to ground in a few seconds within 5 ft, only few move as far as 10 ft Droplet nuclei are carried in air currents for minutes or hours and undergo sedimentation at 10 ft
  • Unfortunately, routine screening for HBsAg is not done in many hospitals, Although 80% of adults in Dar es Salaam appear to have protection against HBV, still there is serious risk of infection following transfusion.
  • Nosocomial infections

    1. 1. NOSOCOMIAL INFECTIONS Eligius Lyamuya MD, MMed, PhD Department of Microbiology and Immunology Muhimbili University of Health and Allied Sciences
    2. 2. LEARNING OBJECTIVES <ul><li>Know the epidemiology of nosocomial infections </li></ul><ul><li>Understand the various modes of transmission of nosocomial infections </li></ul><ul><li>Know the various strategies for prevention and control of nosocomial infections </li></ul>
    3. 3. DISPOSITION <ul><li>Overview </li></ul><ul><li>Epidemiology </li></ul><ul><li>Transmission </li></ul><ul><li>Prevention and control </li></ul>
    4. 4. OVERVIEW <ul><li>Nosocomial infections are hospital-acquired infections </li></ul><ul><li>Categories: </li></ul><ul><ul><li>Infections contracted and developing within hospital eg postoperative wound infection </li></ul></ul><ul><ul><li>Infections contracted in hospital but not becoming clinically apparent until after discharge </li></ul></ul><ul><ul><li>Infections contracted by hospital staff as a consequence of their occupation eg hepatitis B </li></ul></ul>
    5. 5. EPIDEMIOLOGY: Magnitude <ul><li>Magnitude of nosocomial infections in Tanzania unknown </li></ul><ul><li>Generally, widely believed that nosocomial infections occur in 5-10% of admitted patients </li></ul><ul><li>In developed countries e.g USA nosocomial infections develop in at least 5% of patients admitted to hospitals </li></ul>
    6. 6. EPIDEMIOLOGY: Risk factors <ul><li>Risk factors factors: </li></ul><ul><ul><li>Impaired natural resistance to infection </li></ul></ul><ul><ul><li>Pre-existing disease eg. diabetes, immunodeficiency states, etc. </li></ul></ul><ul><ul><li>Immunosuppresive therapy: cytotoxic drugs, radiotherapy etc. </li></ul></ul><ul><ul><li>Bypass of defence mechanisms of body surfaces eg. indwelling catheters, tracheostomy, etc. </li></ul></ul><ul><ul><li>Antibiotic treatment  selective pressure on microbial flora  resistant and virulent strains </li></ul></ul>
    7. 7. EPIDEMIOLOGY: Impact <ul><li>Prolongation of hospital stay </li></ul><ul><li>(in USA, estimated at average extension of 4 days) </li></ul><ul><li>Responsible for significant mortality </li></ul><ul><li>(in USA, directly accounts for an estimated 60,000 deaths per year) </li></ul><ul><li>Significantly increase health care expenditure </li></ul><ul><li>(in USA, adds $10 billion to the national health care expenditure) </li></ul>
    8. 8. TRANSMISSION: Sources <ul><li>Exogenous </li></ul><ul><ul><li>Another person (cross-infection) </li></ul></ul><ul><ul><li>Contaminated items (environmental infection) </li></ul></ul><ul><li>Endogenous </li></ul><ul><ul><li>From patient’s own skin, GIT or URT flora (self-infection) </li></ul></ul>
    9. 9. TRANSMISSION: Routes <ul><li>Airborne </li></ul><ul><ul><li>From the respiratory tract through talking, sneezing, coughing </li></ul></ul><ul><ul><li>From skin by natural shedding of skin scales, wound dressing, bed making </li></ul></ul><ul><ul><li>By aerosols from equipment eg. Respiratory apparatus and air conditioning plant </li></ul></ul><ul><li>Contact </li></ul><ul><ul><li>Direct from person to person </li></ul></ul><ul><ul><li>Indirect via contaminated hands or equipment </li></ul></ul><ul><ul><li>Contaminated “sharp” injury </li></ul></ul>
    10. 10. Commonly occurring microorganisms in hospital infection Others Anaerobes Proteus VHF viruses Coagulase negative staphylococci CMV Pseudomonas HCV Klebsiella HBV E. coli Candida albicans HIV S. aureus Fungi Viruses Bacteria
    11. 11. PREVENTION AND CONTROL <ul><li>Establishment of infection control program </li></ul><ul><li>Sterilization </li></ul><ul><li>Aseptic techniques </li></ul><ul><li>Cleaning and disinfection </li></ul><ul><li>Skin decontamination </li></ul><ul><li>Safe disposal of hospital waste </li></ul><ul><li>Protective clothing </li></ul><ul><li>Prophylactic antibiotics </li></ul><ul><li>Isolation </li></ul><ul><li>Hospital building and design </li></ul><ul><li>Personnel welfare </li></ul><ul><li>Provision of safe blood </li></ul><ul><li>Surveillance </li></ul>
    12. 12. Establishment of infection control program <ul><li>Primary role is to reduce the risk of hospital-acquired infection, thereby protecting patients, HCP and visitors </li></ul><ul><li>The functions of the program include: development of infection control policies and procedures, develop occupational health guidelines for HCP, surveillance, outbreak investigation, education, review of antibiotic utilization vis-à-vis organism antimicrobial susceptibility data, new product evaluation, research and consultancy in academic settings. </li></ul>
    13. 13. Sterilization <ul><li>Sterilization is the destruction of all forms of life including spores </li></ul><ul><li>Provision of sterile instruments, dressings and fluids is of fundamental importance </li></ul><ul><li>Sterilization practices alone will not prevent spread of infection if there is carelessness in its use </li></ul>
    14. 14. Aseptic techniques <ul><li>“ No touch” techniques coupled with strict personal hygiene is essential </li></ul><ul><li>These routines are rigidly laid down in operating theatre practice and may be modified as required for other procedures eg. wound dressing, catheterization etc. </li></ul>
    15. 15. Cleaning and disinfection <ul><li>Cleaning is the removal of dirty. Basic cleaning is indispensable in keeping the hospital environment in good order. </li></ul><ul><li>Disinfection refers to elimination of all vegetative microorganisms; not bacterial or fungal spores, from an inanimate object </li></ul><ul><ul><li>Disinfectants should be used according to laid down guidelines </li></ul></ul><ul><ul><li>Regular monitoring of in-use efficacy is essential. </li></ul></ul><ul><ul><li>Sodium hpochlorite recommended for disinfection of surfaces contaminated with HIV, HBV and HCV infected samples </li></ul></ul>
    16. 16. Safe disposal of hospital waste <ul><li>Type Disposal method </li></ul><ul><li>Sharp objects A, I </li></ul><ul><li>Blood and blood products C </li></ul><ul><li>Waste from patients with </li></ul><ul><li>infectious disease GIPH </li></ul><ul><li>Microbiological samples A, I </li></ul><ul><li>Pathologic tissue I </li></ul><ul><li>A= autoclaving; I= incineration; C= chemical sterilization; </li></ul><ul><li>GIPH= guidelines for Isolation Precautions in Hospitals </li></ul>
    17. 17. Skin decontamination <ul><li>The ease of transfer and acquisition of microbial contaminants via the hands is an important in spread of hospital infection </li></ul><ul><li>Thorough hand washing after and before any procedure involving patient contact is essential. </li></ul><ul><li>Use of antiseptics in certain situations may also be beneficial. </li></ul><ul><li>Antiseptic is a substance applied to skin or living tissue that prevents or arrests growth or action of microorganisms either by inhibiting their activity or by destroying them. </li></ul>
    18. 18. Prophylactic antibiotics <ul><li>Rational antibiotic prophylaxis plays an important role in infection control </li></ul><ul><ul><li>Peri-operative prophylaxis vs anaerobes in GIT and Gyn surgery </li></ul></ul><ul><ul><li>Urological surgery </li></ul></ul><ul><li>Widespread and haphazard use of antibiotics hastens emergence of antibiotic resistant bacteria </li></ul><ul><li>Need to have an antibiotic policy that limits the choice of antibiotics both for prophylaxis and management </li></ul>
    19. 19. Protective clothing <ul><li>Different activities within the hospital require different degrees of protection to staff and patients </li></ul><ul><li>Components of protective gear: </li></ul><ul><ul><li>Gown </li></ul></ul><ul><ul><li>Apron </li></ul></ul><ul><ul><li>Face masks </li></ul></ul><ul><ul><li>Gloves </li></ul></ul><ul><ul><li>Headgear </li></ul></ul><ul><ul><li>Goggles </li></ul></ul><ul><ul><li>Boots </li></ul></ul>
    20. 20. Isolation <ul><li>Source isolation is needed to prevent spread of specific infections to other patients </li></ul><ul><li>Protective isolation is intended to protect susceptible or immunocompromized patients from infection </li></ul>
    21. 21. Hospital building and design <ul><li>Routine maintenance of hospital buildings to ensure ease of cleaning </li></ul><ul><li>Involve infection control team in new hospital construction, or modification of existing building </li></ul><ul><li>Pay special emphasis to operating theatres, kitchen, acute wards, laboratories and air-conditioning systems </li></ul>
    22. 22. Personnel welfare <ul><li>Pre-service screening and immunization where indicated </li></ul><ul><li>Provision of PEP when required </li></ul>
    23. 23. Provision of safe blood <ul><li>Pre-transfusion screening of donor blood for transfusion transmissible infections like HIV, HBV, HCV etc. is essential to make blood safe for those in need </li></ul><ul><li>Irradiation or heat treatment of blood products e.g. clotting factors according to standard recommendations </li></ul>
    24. 24. Surveillance <ul><li>Regular laboratory testing of appropriate specimens to generate data that will alert infection control team to unusual clusters of infection or to the sporadic appearance of microorganisms that may present a particular infection risk or management problem </li></ul><ul><li>Bacterial typing schemes, antibiograms etc. </li></ul>