HAI HAI - HOSPITAL ASSOCIATED INFECTION HAI - HOSPITAL ACQUIRED INFECTION a NASO- COMIAL INFECTION HAI HAI HOSPITAL HAI - HEALTH CARE ASSOCITED INFECTION HEALTH CARE ASSOCIATED AFTER 24 hours Within 48 hrs Back with infection With in 30 days
HOSPITAL ASSOCIATED INFECTION When a infection manifested within 48 hours of admission. Patient is incubating from a outside infection. HOSPITAL ACQUIRED INFECTION These are infections that are a result of treatment in a hospital or a healthcare service unit. Infections are considered nosocomial if they first appear 48 hours or more after hospital admission or within 30 days after discharge. Nasocomial comes from the Greek word ‘ nasokomeio ’. noses= disease, komeo= to takecare of HEALTH CARE ASSOCITED INFECTION The modern CDC definition of hospital acquired infection is Healthcare associated infection. Healthcare-associated infections are infections that patients Acquire during the course of receiving healthcare treatment for other conditions
IMPORTANCE OF HAI In the United States , the Centers for Disease Control and Prevention estimate that roughly 1.7 million hospital-associated infections, from all types of microorganisms , including bacteria , combined, cause or contribute to 99,000 deaths each year In Europe , where hospital surveys have been conducted, the category of Gram-negative infections are estimated to account for two-thirds of the 25,000 deaths each year. Nosocomial infections can cause severe pneumonia and infections of the urinary tract , bloodstream and other parts of the body. Many types are difficult to attack with antibiotics, and antibiotic resistance is spreading to Gram-negative bacteria that can infect people outside the hospital.(Wikipedia)
PREVALANCE OF HAI • USA: Up to 2 million healthcare-associated infections per year, of which 80,000 are lethal or may contribute to death (3) • Europe: 5 million HAI per year, of which 50,000 (1%) are lethal and contribute to death in 135,000 cases (2.7%) (4) • Japan: Resistance Isolation Rate of MRSA (methicillin-resistant Staphylococcus aureus): 40-80% • India: An estimated 10 to 30% of patients admitted to hospitals and nursing homes acquire a nosocomial infection (5) • Up to 70% of organisms causing HAI are resistant to at least one antibiotic (6) (www.biomerieux-diagnostics.com/upload/HAI_KeyFigures.pdf)
DYNAMICS OF HOSPITAL INFECTION THREE FACTORS: THREE PROCESS H OST A GENT I NTIMATE ENVIRONMENT
THREE PROCESS: HAI H OST A GENT I NTIMATE ENVIRONMENT I NJECTION TO HOST A VEHICLE OF TRANSPORTATION H AVE A PORTAL OF EXIST
PREVENTION OF INFECTION A VOID TRANSMISSION H EALTH EDUCATION I SOLATION OF PATIENT 1 2 3
1 HEALTH EDUCATION H AVE A LL I NFORMED
Inform all about hospital guidelines for infection control.
Give health education to staff, patient, relatives regarding aseptic practices.
Mode of spread and how to prevent it.
Regular Medical Examination.
Proper disposal of fomites.
2. AVOID TRANSMISSION A LERT SERVILLANCE SYSTEM H OSPITAL INFECTION CONTROL COMMITTEE I NSERVICE TRAINING A B C
MODE OF TRANSMISSION DIRECT INDIRECT SELF PERSON TO PERSON BY AIR BY FOMITES VECTOR AEROSAL DROPLETS
A . HOSPITAL INFECTION CONTROL COMMITTEE MED. SUPDT. - CHAIRMAN ALL HODs - MEMBER Nursing. Supdt. - MEMBER I/C CSSD - MEMBER I/C SANITATION/ KITCHEN - MEMBER MICROBIOLOGIST - MEMBER SECRETARY
To form policies, rules and guidelines to be followed in all parts
of the hospital.
Methods of sterilization of equipments and dressing.
Management of Hospital Waste.
Periodic Health check up
Immunization of Hospital Staff.
Pest Control Measures.
B. ALERT SURVEILLANCE SYSTEM HOSPITAL SURVEILLANCE SYSTEM IDENTIFICATION THROUGH INVESTIGATION ANALYSIS REPORTING RESEARCH PREVENTION CONTROL COUNTER
INFECTION CONTROL NURSE
Implementation and monitoring of infection control guidelines.
Collection of infection data through departmental report.
Collection of lab. reports.
Analysis of data and reporting to the higher up.
C. IN SERVICE TRAINING TRAINING & PRACTICES IN PREVENTION H EALTHY ENVIRONMENT A PPROPRIATE BMW DISPOSAL I NDUCING ASEPTIC PROCEDURES & PRACTICES
Pest control & Vector Control Measures
Wet Moping of floor.
Proper BMW Disposal
Disinfection & disposal of fomites
Safe Drinking Water
Hospital Structural Survey
Modular OTs & Laminar Flow
ASEPTIC PROCEDURES & PRACTICES
- Hand washing before and after touching the patient.
before and after all procedures.
before and after handling fomites.
Use of protecting gowns, masks, gloves.
Use no touch technique.
Sharps to be handled with care.
Clean all spill-ups, blood with hypo solution.
Use sterile gauze, cotton and instruments for dressing.
3. ISOLATION OF PATIENT
Patient to be isolated/ separated.
Minimum interfere with the patient.
Attending staff must be properly immunized.
Fomites to be treated with hypo solution before disposal.
Use of mask by patient .
CONTROL OF INFECTION A PPLY SPECIFIC ASEPTIC TECHNIQUES H EALTH PROMOTION I NFECTION COUNTER
Increase host resistance and decrease susceptibility.
Use of prophylactive therapy and immuno globuline.
Immunization against infectious diseases.
Nutritious and balance diet.
Carrier detection and treatment .
FOUR MAJOR NASOCOMIAL INFECTIONS URINARY TRACT RESPIRATORY TRACT BLOOD STREAM SURGICAL WOUND VENTILATOR ASSOCIATED PNEUMONIA ASPIRATION SURGICAL PNEUMONIA POST OPERATIVE CHEST DRAINGE TRACHEOSTOMY WOUND BLOOD TRANSFUSION I.V INJECTION, DRIPS SEPTICAEMIA
URINARY TRACT INFECTION
Always avoid using catheter.
If needed do intermittent Catheterization.
Use small bore catheter and proper lubrication.
If indwelling catheter is indicated use a closed
drainage system or condom catheter drainage .
RESPIRATORY INFECTION PNEUMONIA
Proper sterilization of tubing, respirator and humidifier.
No frequent change of respiratory tubes.
Sterile suction in head up position.
Avoid swallowing upper air way secretion in unconscious patients.
Physiotherapy to assist drainage.
Avoid liquid orally in unconscious patients.
Practice sterile surgical wound management.
Break the chain of dynamic transmission.
Destroy the agent of disease by treatment.
Vector Control Measure.
Wet Mopping of floor.
Proper disposal of BMW.
Early diagnosis and prompt treatment.
Regular Surveillance and identification of source of infection.
Proper sterilization of equipments and dressing materials.
Use of protective gowns, mask and gloves.
ROLL OF HOSPITAL STAFF IN PREVENTING HAI.
H ave A I nsight
Are you suffering from an infection?
Are you a carrier of any infection?
Do you know hospital infection control rules and regulation?
Are you praticing aseptic hospital procedures?
Are you taking part in health education?
Are you reporting abuot hospital infection.?
Are you following barrier nurshing in infected cases?
Are yu washing hand before and after touching patient?
ARE you ensuring proper segregation of BMW?
Are you using protective gears when in isolation ward?
Are you immunised against hepatitis B?
H ave A ll I nformed
Inform all,about hospital guide line for hospital inf. control .
Teach aseptic pratice to patient,relatives and visitors.
How to suspect hospital infection.
Teach all hand washing and universal precaution.
Proper treatment of fomites.
Proper segregation and disposal of BMW.
SPECIFIC ROLE OF HOSPITAL EMPLOYEES HAI HOST PROTECTION AGENT DESTRUCTION INFECTION PREVENTION ROLE OF:- DOCTOR NURSE PARAMEDICS ROLE OF STAFF DOCTOR NURSE PARAMEDICS ROLE OF STAFF DOCTOR NURSE PARAMEDICS ROLE OF STAFF DOCTOR NURSE PARAMEDICS
Surveillance of patient for suspected HAI
On suspicion send sample for culture and sensitivity.
Investigate cause and prevent spread.
Ensure infection control guidelines followed.
Restrict over crowding and visitors to infected patient.
Regular medical checkup of staff for carriers.
Carriers must not be posted in sensitive wards.
Immunise hospital staff against hepatitisB.
HOST PROTECTION B. NURSES Barrier nursing to all infected cases. Issue fresh and clean linen to patients. Chang bed sheet and patient dress regularly. Encourage use of disposables. Washing of hands before and after touching patient. Proper sterilisation of instruments and dressings. Routine bacteriological sampling for test. Storing instruments and linens in close cabinets. Disinfect linen in hypo chloride before sending to laundry. Ensure sanitary house keeping and pest control. Restrict visitors, and give health education. Separate trolley for clean and dirty supplies
HOST PROTECTION C. PARAMEDICS Good and hygienic house keeping. Wet mopping of floors to avoid dust. Disinfect the bed after death or discharge of infected patient. Proper segregation of waste, and washing of hands. Spray of insecticide to prevent vector born diseases. Assist nurse in restricting visitors. Transport clean and dirty in separate trolley. And samples to lab carefully.
. Destroy the agent through sensitive antibiotics.
Avoid discriminate use of antibiotics to make organism resistant
Disinfect dressings, soiled linen and instruments, syringes
Washing of hands with mild detergents or antiseptic handwash
before and after procedures.
Proper handling of infected materials and fomites.
Sanitary disposal of waste.
Disinfection of soiled linen ,blood ,vomits, urine of infected case.
Disinfection of syringes needles, gloves before discard.
Incinerate or autoclave infected waste as pre rule.
Periodic medical checkup of medical stff.
Formation of hospital infection control committee.
Antibiotic policy in hospital.
Random sample testing from sensitive areas like OT,ICU, CCU ,Isolation ward.
Investigation of all hosital infection ases and remedial measures.
Detection of MDR bacteria and change in antibiotic police.
Immunisation against hepatitis and typhoid.
Proper disposal of BMW.
Follow universal precaution.
Strictly follow aseptic precaution guide lines.
Sur veillance of suspected infection cases.
Education of patients and relatives to prevent infection
Proper sanitation and house keeping.
Proper segreegation of waste. C. PARAMEDICS
Help in maintaining general sanitation.
Get exmined and treated if ill.
Follow the asepti guide lines like hand washing.
Take part in ifection surveillance.
Adequate pest and vector control measure.
UNIVERSAL WORK PRECAUTIONS
The basic principle for preventing infection hazard is the adoption of universal precautions which have been developed to minimize the exposure to patient fomites.
Wash hands after patient contact, or with body substance
Plan safe handling and disposal before beginning any procedure
Dispose of used needles promptly in sharp disposal containers
Wear gloves when contamination of hands with body substances is anticipated
Protective eyewear and masks should be worn when splashing with body substances/fluids is anticipated
Adhere to disinfection and sterilization standards
Regard all waste soiled with blood/body substances as contaminated and dispose of according to BMW rules.
Vaccinate all clinical and laboratory workers against hepatitis B
INFECTION CONTROL EFFORTS
Use of standard precautions including Implementation of the 6 step Hand wash technique.
Safety in clinical procedures of an invasive or semi-invasive nature.
Regular supply of protective material to prevent HAI in staff
Blood and blood product safety
Safe injection practices
Management of blood or blood product spills
Monitoring the operation room
Monitoring the Environment
Sterilization and disinfection practices
Central Sterile Supply Department
INFECTION CONTROL EFFORTS
Laboratory Surveillance: monitoring, preventing and control of HAI
Protection of Health care worker – post exposure Prophylaxis, Immunization etc.
Designing of hospital Intensive Care Unit, operation theatre, nurseries etc.
Ensuring Safe Water supply and sanitation.
CONSTRAINTS IN CONTROLLING HAI
Globally HAI continues as major problem.
Antibiotic resistant organisms are growing day by day.
Emerging infectious pathogens with drug resistance.
Increasing costs of antibiotics.
Irrational use of antibiotics by Quacks.
Lack of proper legislation for implementation of best practice
Lack of specialized referral Laboratory surveillance
Lack of awareness among staff.
No facilities for regular education and training.. ”
Increasing awareness of the populace with “consumerism.
Increase of International Medical Health Tourism to India
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