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Dr.T.V.Rao MD   Dr.T.V.Rao MD   1
A Tribute to    Ignaz Semmelweiss (1818-1865)Ignaz Semmelweiss (1818-1865)   Obstetrician, practised in   Vienna   Studied...
What is Hospital Acquired         Infections Any infectionthat is notpresent orincubating at thetime the patientis admitte...
Consequences of Hospital Acquired           Infections  Additional morbidity  Prolonged  hospitalization  Long-term physic...
Why Everyone Concerned with     Hospital InfectionsThe Centers for DiseaseControl (CDC) estimatesthat 2 million U.S. patie...
What is Infection ControlInfection control is the discipline concerned withpreventing nosocomial or healthcare-associated ...
Infection Control is Complex         programmeInfection control addresses factors related to the spread ofinfections withi...
Beginning of Hospital Infection         ProgrammeModern hospital infectioncontrol programs first began inthe 1950s in Engl...
Centre For Disease Control and          Prevention                             The Communicable                           ...
CDC Initiates Hospital   Infection Branch                         In 1972, the Hospital                         Infections...
First Data on Infection Control            EfficacyIn 1985, the Study of theEfficacy of NosocomialInfection Control (SENIC...
Joint Commission on Accreditation of  Healthcare Organizations (JCAHO)In 1969, the JointCommission forAccreditation of Hos...
CDC formulates Guidelines on     Infection Control                            In 1972, the Hospital                       ...
Break the Chain of Infections1. Organisms that cancause infection aresubject to riskassessment under theCOSHH regulationsa...
Risk assessment of Substances        in use for ICP Various substances such as disinfectants used to prevent cross infecti...
Beginning of AIDS Pandemic Necceciates       Stronger Infection Control ProtocolsThe second and certainly mostsignificant ...
Study of the Efficacy of Nosocomial Infection Control (SENIC) projectStudy of the Efficacy of Nosocomial Infection Control...
Infection Control Challenges of           Healthcare in 2000Decreasing reimbursementIncreasing emerging infectionsIncreasi...
Infection control was influenced by the   reform of the Healthcare SystemInfection control programs had to encompass not o...
Changing Demands on Infection     Control programmeTodays ICP needsknowledge ofepidemiology statistics,patient care practi...
Infection Control Committee and Antibiotic Policies are         Back bone for reduction of Infections                     ...
Major Responsibilities of I C PThe major responsibilities for ICPs to oversee includesurveillance, specific environmental ...
GUIDELINES AND    RECOMMENDATIONSHand washing andHospital EnvironmentalControl* Immunization* Infectious DiseasesControl* ...
Good House Keeping a Boon to      Infection Control            Dr.T.V.Rao MD      24
Scientific Disinfection Practices      Saves Several Lives                              Long-Term Care Facilities         ...
SurveillanceThe key to ongoingmonitoring is surveillancefor nosocomial infections.Various techniques forsurveillance have ...
Computerized Surveillance                          Surveillance traditionally                          involved significan...
Infection Control programme is       Hospital Oriented                            ICPs should evaluate their              ...
Outbreak InvestigationsUnlike scheduled activities,occasional clusters ofpatients who are colonizedor infected will trigge...
Infection Control ProgrammeIntegrated with Health Authorities                          The institution usually makes the  ...
Formulating an Infection Control             PlanEvery infection control program should develop a well-defined written pla...
Staff Training in ICPEducation programs for employeesand volunteers are one method toensure competent infection controlpra...
Infection Control Programme and           DocumentationGoals of the infectioncontrol program need tobe incorporated into t...
Document Antibiograms with       WHONETWHONET is a freeWindows-based databasesoftware developed forthe management andanaly...
CDC Guides the Medical profession                            ICP  CDC with the Hospital Infection Control Practices Adviso...
Health Care Means In patient  care and outpatient careSignificant trends inhealthcare are occurringeveryday including newm...
Dr.T.V.Rao MD   37
Light technology to combat         Hospital InfectionsA pioneering lighting systemthat can kill hospital superbugs– includ...
Light technology to combat hospital             infectionsThe technology decontaminates the air and exposedsurfaces by bat...
Light Technology to Combat Hospital             InfectionsHINS-light is a safe treatmentthat can be easily automated topro...
Medical Dressing Uses Nanotechnology to Fight InfectionScientists at the Universityof Bath and the burns teamat the Southw...
New Bandages Change Color If      Infections Arise                           The dressing will                           w...
New Nanotechnology for Hospital Infection    Control Receives FDA Approval                                 SilvaGard can b...
Dr.T.V.Rao MD   44
Long Sleeves x Short SleevesResults from a study by DenverHealth and University of ColoradoHealth Services Center research...
. Vision-based hand gesture recognition                      TechnologyThe technology relies on handgestures as commands, ...
Involvement of Physicians More             ImportantPhysicians to be more involvedand lead quality improvementefforts in t...
Scientific Documentation Reduces        Hospital Infections Researchers evaluated the effect of an electronic medical reco...
Impact of Hand Washing on         Influenza                        Health experts believe a flu                        epi...
Hand Hygiene ComplianceResearchers have implemented a handhygiene program driven by abehavioral change approach to increas...
Which Skin Preparation Agent is          Superior                             Researchers conducted a review of surgical  ...
Health Care Workers are at Risk –       Need for VaccinationHealth care workers may be exposed to certain infections in th...
Become a Member of Alliance for the Prudent Use of Antibiotics (APUA)          www.apua.org                               ...
Created by Dr.T.V.Rao MD for ‘e ‘ learningresources for Infection Control Personal in          the Developing World       ...
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Hospital infection control programme

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Hospital infection control programme

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  1. 1. Dr.T.V.Rao MD Dr.T.V.Rao MD 1
  2. 2. A Tribute to Ignaz Semmelweiss (1818-1865)Ignaz Semmelweiss (1818-1865) Obstetrician, practised in Vienna Studied puerperal (childbed) fever Established that high maternal mortality was due to failure of doctors to wash hands after post-mortems Reduced maternal mortality by 90% Ignored and ridiculed by colleagues Dr.T.V.Rao MD 2
  3. 3. What is Hospital Acquired Infections Any infectionthat is notpresent orincubating at thetime the patientis admitted tothe hospital Dr.T.V.Rao MD 3
  4. 4. Consequences of Hospital Acquired Infections Additional morbidity Prolonged hospitalization Long-term physical, developmental and neurological sequelae Increased cost of hospitalization Death Dr.T.V.Rao MD 4
  5. 5. Why Everyone Concerned with Hospital InfectionsThe Centers for DiseaseControl (CDC) estimatesthat 2 million U.S. patients ayear acquire hospital-relatedinfections. These infectionscost an average of $47,000per patient to treat andcause 90,000 deaths eachyear. The added cost tohospitals is $4.8 billionannually in extended careand treatment. Dr.T.V.Rao MD 5
  6. 6. What is Infection ControlInfection control is the discipline concerned withpreventing nosocomial or healthcare-associated infection.As such, it is a practical (rather than an academic) sub-discipline of epidemiology. It is an essential (though oftenunder-recognized and under-supported) part of theinfrastructure of health care. Infection control andhospital epidemiology are akin to public health practice,practiced within the confines of a particular health-caredelivery system rather than directed at society as a whole. Dr.T.V.Rao MD 6
  7. 7. Infection Control is Complex programmeInfection control addresses factors related to the spread ofinfections within the health-care setting (whether patient-to-patient, from patients to staff and from staff topatients, or among-staff), including prevention (via handhygiene/hand washing,cleaning/disinfection/sterilization, vaccination,surveillance), monitoring/investigation of demonstratedor suspected spread of infection within a particularhealth-care setting (surveillance and outbreakinvestigation), and management (interruption ofoutbreaks). Dr.T.V.Rao MD 7
  8. 8. Beginning of Hospital Infection ProgrammeModern hospital infectioncontrol programs first began inthe 1950s in England, wherethe primary focus of theseprograms was to prevent andcontrol hospital-acquiredstaphylococcal outbreaks. In1968, the American HospitalAssociation published"Infection Control in theHospital," the first and onlystandards available for manyyears. Dr.T.V.Rao MD 8
  9. 9. Centre For Disease Control and Prevention The Communicable Disease Center, later to be renamed the Centers for Disease Control and Prevention (CDC), began the first training courses specifically about infection control and surveillance. Dr.T.V.Rao MD 9
  10. 10. CDC Initiates Hospital Infection Branch In 1972, the Hospital Infections Branch at the CDC was formed and the Association for Practitioners in Infection Control was organized. By the close of the decade, the first CDC guidelines were written to answer frequently asked questions and establish consistent practice. Dr.T.V.Rao MD 10
  11. 11. First Data on Infection Control EfficacyIn 1985, the Study of theEfficacy of NosocomialInfection Control (SENIC)project was published,validating the cost-benefit ofinfection control programs.Data collected in 1970 and1976-1977 suggested thatone-third of all nosocomialinfections could beprevented Dr.T.V.Rao MD 11
  12. 12. Joint Commission on Accreditation of Healthcare Organizations (JCAHO)In 1969, the JointCommission forAccreditation of Hospitals--later to become the JointCommission onAccreditation of HealthcareOrganizations (JCAHO)--first required hospitals tohave organized infectioncontrol committees andisolation facilities Dr.T.V.Rao MD 12
  13. 13. CDC formulates Guidelines on Infection Control In 1972, the Hospital Infections Branch at the CDC was formed and the Association for Practitioners in Infection Control was organized. By the close of the decade, the first CDC guidelines were written to answer frequently asked questions and establish consistent practice. Dr.T.V.Rao MD 13
  14. 14. Break the Chain of Infections1. Organisms that cancause infection aresubject to riskassessment under theCOSHH regulationsand Management ofHealth and Safety atWork Regulation1992. Dr.T.V.Rao MD 14
  15. 15. Risk assessment of Substances in use for ICP Various substances such as disinfectants used to prevent cross infection are subject to risk assessment prior to use. Health and Safety guidance highlights the importance of the risk assessment process i.e. Identify the risk Assess the risk Note current measures which are being used to control or mitigate the risk Inform/train staff Monitor outcomes Implement policies and procedures Dr.T.V.Rao MD 15
  16. 16. Beginning of AIDS Pandemic Necceciates Stronger Infection Control ProtocolsThe second and certainly mostsignificant factor influencinginfection control at the time wasthe advent of acquiredimmunodeficiency syndrome(AIDS). The humanimmunodeficiency virus (HIV)has taken an enormous toll interms of loss of life andproductivity. For infectioncontrol professionals (ICPs),HIV has been a challenge foreducation, risk reduction andresource utilization. Dr.T.V.Rao MD 16
  17. 17. Study of the Efficacy of Nosocomial Infection Control (SENIC) projectStudy of the Efficacy of Nosocomial Infection Control (SENIC)project was published, validating the cost-benefit of infectioncontrol programs. Data collected in 1970 and 1976-1977suggested that one-third of all nosocomial infections could beprevented if all the following were present:One infection control professional (ICP) for every 250 beds.An effective infection control physician.A program reporting infection rates back to the surgeon andthose clinically involved with the infection.An organized hospital-wide surveillance system. Dr.T.V.Rao MD 17
  18. 18. Infection Control Challenges of Healthcare in 2000Decreasing reimbursementIncreasing emerging infectionsIncreasing resistant organismsIncreasing drug costsInstitute of Medicine Report--healthcare-associated infectionsNursing shortageOSHA safety legislationMultiple benchmark systemsFDA legislation on reuse of single-use devices Dr.T.V.Rao MD 18
  19. 19. Infection control was influenced by the reform of the Healthcare SystemInfection control programs had to encompass not onlyhospitals but also the long-term care facility, homehealth/hospice, rehabilitation facilities, free-standing surgicalcenters, and physician office practices. A dramatic shift inpatient care practices occurred as greater than 65% of surgerycases were operated on in an outpatient setting. Issues that willcontinue to impact infection control programs into the newmillennium are a challenging combination of cost and clinicalfactors and increasing cost to treat infections, and financialimpact of implementing new government regulations . Dr.T.V.Rao MD 19
  20. 20. Changing Demands on Infection Control programmeTodays ICP needsknowledge ofepidemiology statistics,patient care practices,occupational health,sterilization, disinfection,and sanitation, infectiousdiseases, microbiology,education andmanagement Dr.T.V.Rao MD 20
  21. 21. Infection Control Committee and Antibiotic Policies are Back bone for reduction of Infections Dr.T.V.Rao MD 21
  22. 22. Major Responsibilities of I C PThe major responsibilities for ICPs to oversee includesurveillance, specific environmental monitoring,continuous quality improvement, consultation,committee involvement, outbreak and isolationmanagement, regulatory compliance and education. Toplan, coordinate, and succeed in fulfilling theseresponsibilities, many ICPs have to redefine their roles.More ICPs are becoming managers by creatingmultidisciplinary support teams to carry out many of thefunctions. Dr.T.V.Rao MD 22
  23. 23. GUIDELINES AND RECOMMENDATIONSHand washing andHospital EnvironmentalControl* Immunization* Infectious DiseasesControl* Intravascular Device-Related Infections and itscontrol* Isolation Precautions Dr.T.V.Rao MD 23
  24. 24. Good House Keeping a Boon to Infection Control Dr.T.V.Rao MD 24
  25. 25. Scientific Disinfection Practices Saves Several Lives Long-Term Care Facilities * *Guidelines for Infection Control in Health Care Personnel * Surgical Site Infections Control * Urinary Tract and Respiratory Tract Infections Control * Ordering and Preparing Guidelines appropriately * Home care * Hospital Construction * Sterilization / Disinfection Dr.T.V.Rao MD 25
  26. 26. SurveillanceThe key to ongoingmonitoring is surveillancefor nosocomial infections.Various techniques forsurveillance have beendescribed and evaluatedincluding total housesurveillance, targetedsurveillance, Kardex, orlaboratory-base Dr.T.V.Rao MD 26
  27. 27. Computerized Surveillance Surveillance traditionally involved significant manual data assessment Increasingly, integrated computerized software solutions are becoming available that assess incoming risk messages from microbiology and other online sources. By reducing the need for data entry, this software significantly reduces the data workload of ICPs, freeing them to concentrate on clinical surveillance. Dr.T.V.Rao MD 27
  28. 28. Infection Control programme is Hospital Oriented ICPs should evaluate their institutional needs and develop a surveillance plan to present to the infection control committee on a yearly basis. Choosing one or two specific surveillance problems and setting a goal for reduction will focus the efforts of the ICP. JCAHO requires documenting the rationale for selecting a specific surveillance approach Dr.T.V.Rao MD 28
  29. 29. Outbreak InvestigationsUnlike scheduled activities,occasional clusters ofpatients who are colonizedor infected will triggerfurther investigationincluding a case-controlstudy. New laboratorymethods developed andrefined within the lastdecade can now determinehow related the strain is atthe molecular level. Dr.T.V.Rao MD 29
  30. 30. Infection Control ProgrammeIntegrated with Health Authorities The institution usually makes the infection control program responsible for reporting communicable diseases required by state law. ICPs need to plan on interacting with local and state health departments regarding exposure that may need immediate community follow-up (e.g., tuberculosis, Cholera). ICPs should assist the health department in confirming cases that may have been seen in the hospital or clinic. Dr.T.V.Rao MD 30
  31. 31. Formulating an Infection Control PlanEvery infection control program should develop a well-defined written plan outlining the organizationalphilosophy regarding infection prevention and control.The plan should take into account the goals, missionstatement, and an assessment of the infection controlprogram. It should include a statement of authority, andshould review patient demographics includinggeographic locations of patients served by the healthcaresystem Dr.T.V.Rao MD 31
  32. 32. Staff Training in ICPEducation programs for employeesand volunteers are one method toensure competent infection controlpractices. It is a unique challengesince employees represent a widerange of expertise and educationalbackground. The ICP must becomeknowledgeable in adult educationprinciples and use educationaltools and techniques that willmotivate and sustain behavioralchange. Dr.T.V.Rao MD 32
  33. 33. Infection Control Programme and DocumentationGoals of the infectioncontrol program need tobe incorporated into themission statement of thefacility. A missionstatement should tell whoyou are, what you do, andshould communicate aclear view of purpose andset a strategy foraccomplishing the goal Dr.T.V.Rao MD 33
  34. 34. Document Antibiograms with WHONETWHONET is a freeWindows-based databasesoftware developed forthe management andanalysis of microbiologylaboratory data with aspecial focus on theanalysis of antimicrobialsusceptibility test results. Dr.T.V.Rao MD 34
  35. 35. CDC Guides the Medical profession ICP CDC with the Hospital Infection Control Practices Advisory Committee (HICPAC) has produced or revised several major guidelines in the past two years including, Guidelines for Infection Control in Healthcare Personnel, and Guidelines for Management of Healthcare Worker Exposures to HIV and Recommendations for Post exposure Prophylaxis, Guidelines for Prevention of Surgical Site Infections. APIC has developed several guidelines covering topics including antisepsis and hand washing, disinfection and sterilization, endoscopy, and long-term care. Dr.T.V.Rao MD 35
  36. 36. Health Care Means In patient care and outpatient careSignificant trends inhealthcare are occurringeveryday including newmedical procedures (i.e.,gene therapy), newtechnology (multi-purpose intravenouscatheters), and a shiftfrom inpatient tooutpatient care. Dr.T.V.Rao MD 36
  37. 37. Dr.T.V.Rao MD 37
  38. 38. Light technology to combat Hospital InfectionsA pioneering lighting systemthat can kill hospital superbugs– including MRSA and C.diff –has been developed byresearchers at the University ofStrathclyde in Glasgow,Scotland. The technologydecontaminates the air andexposed surfaces by bathingthem in a narrow spectrum ofvisible-light wavelengths,known as HINS-light. Dr.T.V.Rao MD 38
  39. 39. Light technology to combat hospital infectionsThe technology decontaminates the air and exposedsurfaces by bathing them in a narrow spectrum of visible-light wavelengths, known as HINS-light.Clinical trials at Glasgow Royal Infirmary have shownthat the HINS-light Environmental DecontaminationSystem provides significantly greater reductions ofbacterial pathogens in the hospital environment than canbe achieved by cleaning and disinfection alone, providinga huge step forward in hospitals ability to prevent thespread of infection. Dr.T.V.Rao MD 39
  40. 40. Light Technology to Combat Hospital InfectionsHINS-light is a safe treatmentthat can be easily automated toprovide continuousdisinfection of wards and otherareas of the clinicalenvironment. The pervasivenature of light permits thetreatment of air and all visiblesurfaces, regardless ofaccessibility, either throughdirect or reflected exposure toHINS-light within the treatedenvironment Dr.T.V.Rao MD 40
  41. 41. Medical Dressing Uses Nanotechnology to Fight InfectionScientists at the Universityof Bath and the burns teamat the Southwest UKPediatric Burns Centre atFrenchay Hospital in Bristolare working together withteams across Europe andAustralia to create anadvanced wound dressing. Dr.T.V.Rao MD 41
  42. 42. New Bandages Change Color If Infections Arise 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. Dr.T.V.Rao MD 42
  43. 43. New Nanotechnology for Hospital Infection Control Receives FDA Approval SilvaGard can be used to treat virtually any medical device and its use does not alter the devices original properties. Due to these and other unique attributes, SilvaGard is expected to have a significant impact on the battle against hospital- related infections. Dr.T.V.Rao MD 43
  44. 44. Dr.T.V.Rao MD 44
  45. 45. Long Sleeves x Short SleevesResults from a study by DenverHealth and University of ColoradoHealth Services Center researchersshowed there were no statisticallysignificant differences found inbacterial or MRSA counts betweenphysicians’ coats and newlylaundered short-sleeveduniforms.The researchers’ findingssheds new light on Britishgovernment agencies’ policiesbanning physicians’ white coatsbased on the belief that longsleeves carry more bacteria andpose a greater risk of bacterialtransmission Dr.T.V.Rao MD 45
  46. 46. . Vision-based hand gesture recognition TechnologyThe technology relies on handgestures as commands, whichcan control robotic nurses ortell computers to displaypertinent patient healthinformation, Juan PabloWachs, assistant professor ofindustrial engineering atPurdue University works andpopularises.The vision-basedhand gesture recognitiontechnology could also be usedfor the coordination ofemergency response activitiesduring disasters. Dr.T.V.Rao MD 46
  47. 47. Involvement of Physicians More ImportantPhysicians to be more involvedand lead quality improvementefforts in their respectivehealthcare settings. Drs.Pronovost and Marsteller suggestthat even though qualityimprovement efforts exist, there isnot enough data supporting thenotion that quality improvementefforts are actually enhancingpatient outcomes. One of thereasons for this lack of progress,they say, is inadequate physicianengagement and leadership inquality improvement work.Peter Pronovost, MD, PhD, and Jill Marsteller,PhD, MP Dr.T.V.Rao MD 47
  48. 48. Scientific Documentation Reduces Hospital Infections Researchers evaluated the effect of an electronic medical record on the use of antimicrobial agents and infection rates of Clostridium difficile and MRSA. Results showed that implementation of an EMR significantly increased chart reviews and antimicrobial recommendations, leading to a decrease in antimicrobial use and MRSA as well as C. difficile infection rates. Dr.T.V.Rao MD 48
  49. 49. Impact of Hand Washing on Influenza Health experts believe a flu epidemic was averted last year because of regular hand-washing, suggesting healthcare facilities should promote hand-washing among staff and patients to prevent the spread of disease. The American Society for Microbiology and the American Cleaning Institute released a study in Sept. 2010 reporting that 85 percent of people washed their hands in public restrooms in 2008, the highest levels observed since the Dr.T.V.Rao MD research began in 1996. 49
  50. 50. Hand Hygiene ComplianceResearchers have implemented a handhygiene program driven by abehavioral change approach to increasehand hygiene compliance. The handhygiene program was packaged withseveral initiatives. It included access toalcohol sanitizer, education as well asongoing audit and feedback. Theprogram was also supplemented withbehavior modification practices, suchas immediate positive reinforcement aswell as annually changing incentives.The researchers report the program hasresulted in significant and sustainedimprovements in hand hygienecompliance. Dr.T.V.Rao MD 50
  51. 51. Which Skin Preparation Agent is Superior Researchers conducted a review of surgical skin prep agents to conclude which agent was most cost-effective and superior in preventing surgical site infections. Based on information collected from two databases, researchers compared povidone-iodine, Chlorhexidine gluconate, parachoroxylenol and iodine povacrylex (0.7 percent available iodine) in 74 percent isopropyl alcohol (DuraPrep). Researchers concluded that each prep agent has specific advantages and disadvantages and no one skin prep agent is superior in all clinical situations. Factors to consider when choosing a skin prep agent include surgeon preference and environmental risks. Dr.T.V.Rao MD 51
  52. 52. Health Care Workers are at Risk – Need for VaccinationHealth care workers may be exposed to certain infections in thecourse of their work. Vaccines are available to provide someprotection to workers in a healthcare setting. Depending onregulation, recommendation, the specific work function, orpersonal preference, healthcare workers or first respondersmay receive vaccinations for hepatitis B; influenza measles,mumps and rubella; Tetanus, diphtheria, pertussis; N.meningitides; and varicella.The problem of resources for proving Vaccines in Developingcountries continues to be real problem, need additionaleconomic resources Dr.T.V.Rao MD 52
  53. 53. Become a Member of Alliance for the Prudent Use of Antibiotics (APUA) www.apua.org An international organization dedicated to curbing antibiotic resistance Chapters exist currently in several Asian countries: Australia, China, India, Nepal, Pakistan, Philippines, South Korea, Taiwan, Vietnam Dr.T.V.Rao MD 53
  54. 54. Created by Dr.T.V.Rao MD for ‘e ‘ learningresources for Infection Control Personal in the Developing World Email doctortvrao@gmail.com Dr.T.V.Rao MD 54
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