Hospital Acquired InfectionsRole for Everyone by Dr.T.V.Rao MD

1. Hospital Acquired Infections
Role for Everyone
Principles Practice and Prevention
Dr.T.V.Rao MD
Dr.T.V.Rao MD 1

2. The very first
requirement in
a hospital is
that it should do
the sick no
harm
Dr.T.V.Rao MD 2

3. Scientific era continues . . . . .
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 3

4. INFECTION
•Definition: Injurious contamination of
body or parts of the body by bacteria,
viruses, fungi, protozoa and rickettsia
or by the toxin that they may produce.
• Infection may be local or generalized
and spread throughout the body.
• Dr.T.V.Rao MD 4

5. our HOSPITALS ARE A BALANCE OF TWO
FORCES

6. Main Sources of Infection
• Person to person via hands of health-care providers, patients,
and visitors
• Personal clothing and equipment (e.g. Stethoscopes,
flashlights etc.)
• Environmental contamination
• Airborne transmission
• Hospital staff who are carriers
• Rare common-source outbreaks

7. Campaigns to Decrease Infection Rates
•WHO “Clean hands are safer hands”
campaign
•Centres for Disease Control and Prevention
(CDC) “prevent antimicrobial resistance”
campaign in health-care settings
•Institute for Healthcare Improvement (IHI)
“5 million lives” campaign
•Developing country focus

8. Hospital Infection
•Hospital infection is
also called Nosocomial
infection.
•It is the single largest
factor that adversely
affects both the
patient and the
hospital
Dr.T.V.Rao MD' TMC Kollam Kerala 8

9. Organization of an infection control
programme
• As with all other functions of a health care facility, the
ultimate responsibility for prevention and control of
infection rests with the health administrator. The
hospital administrator/head of hospital should:
•
Establish an infection control committee which will in
turn appoint an infection control team; and
provide adequate resources for effective functioning
of the infection control programme.

10. Infection control committee
•An infection control committee provides a forum
for multidisciplinary input and cooperation, and
information sharing. This committee should
include wide representation from relevant
departments: e.g.
management, physicians, other health care
workers, clinical microbiology, pharmacy,
sterilizing service, maintenance, housekeeping
and training services.

11. Reporting the Matters to whom
?
•The committee must
have a reporting
relationship directly to
either administration or
the medical staff to
promote programme
visibility and
effectiveness.

12. The infection control team should:
•A hospital-associated infection prevention
manual containing instructions and practices for
patient care is an important tool. The manual
should be developed and updated by the
infection control team and reviewed and
approved by the committee. It must be made
readily available for health care workers, and
updated in a timely fashion.

13. Sings of Infection
•Once the infectious agent enters the host it
begins to proliferate and reacts with the
defence mechanisms of the body producing
infection symptoms and signs: pain,
swelling, redness, functional disorders, rise
in temperature and pulse rate and
leucocytosis.
Dr.T.V.Rao MD 13

14. The risk of infection is always present.
• Patient may acquire infection before admission to the hospital =
Community acquired infection.
•Patient may get infected inside the hospital =
Nosocomial infection.
• It includes infections not present nor incubating at admission,
infections that appear more than 48 hours after admission, those
acquired in the hospital but appear after discharge also occupational
infections among staff.
Dr.T.V.Rao MD 14

15. Cannot autoclave patients

16. Life is a experience start learning
The TIME IS TICKING

17. HEALTH CARE ASSOCIATED INFECTION
(NOSOCOMIAL)
•Infections that are a
result of health care
delivery, not present at
admission
• EXOGENOUS
• ENDOGENOUS
• IATROGENIC
Refer to Potter & Perry Table 34-2 Pg. 648 (Sites for
Causes of HAI’s)

18. Common Health-Care Associated
Infections
•Urinary Tract Infection
Surgical/Traumatic
Wound Infection
•Respiratory Tract
•Bloodstream

19. Urinary Catheterization
Dr.T.V.Rao MD 19

20. Defining a Nosocomial infection
• A nosocomial infection (nos-oh-koh-mi-al), also
known as a hospital-acquired infection or HAI, is
an infection whose development is favored by a
hospital environment, such as one acquired by a
patient during a hospital visit or one developing
among hospital staff. Such infections include fungal
and bacterial infections and are aggravated by the
reduced resistance of individual patient
Dr.T.V.Rao MD 20

21. 21
Leading causes of death
53.9 million from all causes, worldwide

22. Major Sites of Nosocomial Infections
•Urinary tract infection
•Bloodstream infection
•Pneumonia (ventilator-
associated)
•Surgical site infection

23. Sources of SSIs
• Endogenous: patient’s skin or mucosal flora
• Increased risk with devitalized tissue, fluid collection, edema,
larger inocula
• Exogenous
• Includes OR environment/instruments, OR air, personnel
• Hematogenous/lymphatic: seeding of surgical site
from a distant focus of infection
• May occur days to weeks following the procedure
• Most infections occur due to organisms implanted
during the procedure

24. When you say
Hospital acquired infection
•Infection which was neither present nor
incubating at the time of admission
•Includes infection which only becomes
apparent after discharge from hospital
but which was acquired during
hospitalisation (Rcn, 1995)
•Also called nosocomial infection
Dr.T.V.Rao MD 24

25. Sources of Hospital acquired infections
•1.Patients own flora - Endogenous (50%)
Autoinfection ( Greatest source of
potential danger)
2.Environment - Exogenous(15%)
(Air-5%; Instruments-10%)
3.Another Patient/Staff - Cross Infection (35%)
Dr.T.V.Rao MD 25

26. Burke J Infection control-a problem for patient safety New Eng Journal
of Medicine (February 13, 2003)
Types of Infections

27. ARE OUR HANDS CLEAN
JUST NO
The hands of staff are
the commonest vehicles
by which microorganisms
are transmitted between
patients. Hand washing
is accepted as the single
most important measure
in infection

28. Steps in Hand Washing

29. What to Use for Hand Washing
Alcoholic hand
disinfection is generally
used in Europe, while
hand washing with
medicated soap is more
commonly practised in
the United States.

30. What is the Best Soap to wash
Hands

31. Alcohol-based hand rubs are more effective against most bacteria and
many viruses than either medicated or non-medicated soaps

32. CAN I USE THE ALCHOOL HAND WASH
Require less time to use
Result in a significantly greater
reduction in bacterial numbers than
soap and water in many clinical
situations
Cause less irritation to the skin
Can be made readily accessible to
HCWs
Are more cost effective

33. 33
Three Levels of Infection Control
Sanitization – cleaning
and scrubbing
instruments and
equipment to remove
contaminated materials
and microorganisms
Disinfection – second
level used on
instruments and
equipments that come in
contact with intact
mucous membrane
Sterilization – complete destruction of all microorganisms-
pathogenic, beneficial, and harmless- surface of instrument
and equipment
Dr.T.V.Rao MD

34. 34
Sanitization Methods
Collecting instruments – place in
container with water and neutral pH
detergent until you can get to them.
Use utility gloves always and mask, eye
protection and protective clothing if
blood, body fluids or tissue are present
Dr.T.V.Rao MD

35. Standard Precautions
•Apply standard precautions to all
patients regardless of their diagnosis,
and to all contaminated equipments
and materials.
•Use judgment in determining which
protective barriers are necessary.
Dr.T.V.Rao MD 35

36. Scope of Infection Control
•Aiming at preventing spread of infection:
• Standard precautions: these measures must be applied during every
patient care, during exposure to any potentially infected material or body
fluids as blood and others.
• Components:
• A. Hand washing.
• B. Barrier precautions.
• C. Sharp disposal.
• D. Handling of contaminated material
Dr.T.V.Rao MD 36

37. 1st principale of infection prevention
at least 35-50% of all healthcare-associated infections are
asociated with only 5 patient care practices:
•Use and care of urinary catheters
•Use and care of vascular access lines
• Therapy and support of pulmonary functions
•Surveillance of surgical procedures
•Hand hygiene and standard precautions
Dr.T.V.Rao MD 37

38. Healthcare-Associated Urinary Tract Infection
• Urinary tract infection (UTI) causes ~
40% of hospital-acquired infections
• Most infections due to urinary catheters
• 25% of inpatients are catheterized
• Leads to increased morbidity and costs
Dr.T.V.Rao MD 38

39. Nurses should be Familiar INTERVENTIONS
•ISOLATION PRECAUTIONS
•HYPERTHERMIA INTERVENTION
• ELIMINATE UNDERLYING CAUSE
• FEVER MANAGEMENT
•HEALTH TEACHING
•ANTIBIOTIC THERAPY
•PSYCHOSOCIAL SUPPORT
•HEALTH CARE RESOURCES

40. Read Manuals on Isolation Precautions
• CDC and OSHA Guidelines on
1. Contact
2. Droplet
3. Airborne

41. Why Hand Washing
Dr.T.V.Rao MD 41

42. Impression of my Hand Showing the Growth of
Bacteria

43. HAND WASHING
• Proper hand washing is the single
most important way to prevent
and reduce infections
• Wash and rinse hands for 15
seconds, using a dry paper
towel to turn off faucet
• Alcohol based hand wash is
also available in all patient
care areas
Dr.T.V.Rao MD 43

44. Hands should be washed:
•Before and after patient contact
•Before putting on gloves and after taking
them off
•After touching blood and body substances
(or contaminated patient-care equipment),
broken skin, or mucous membranes (even if
you wear gloves)
Dr.T.V.Rao MD 44

45. HAND WASHING
Hand washing is the single most effective precaution
for prevention of infection transmission between
patients and staff.
Hand washing with plain soap is mechanical removal of
soil and transient bacteria (for 10- 15 sec.)
Hand antisepsis is removal & destroy of transient flora
using anti-microbial soap or alcohol based hand rub (for
60 sec.)
Dr.T.V.Rao MD 45

46. Methods in Hand Washing
• Surgical hand scrub: removal or destruction of transient flora and
reduction of resident flora using anti-microbial soap or alcohol based
detergent with effective rubbing (for least 2-3 min)
• Our hands and fingers are our best friends but still
could be our enemies if they carry infective organisms
and transmit them to our bodies and to those whom
we care for.
•Sinks & soap must be found in every patient care
room. Doctors, nurses must comply to hand
washing policy.
Dr.T.V.Rao MD 46

47. Children too are at Risk from Hospital Infections.
Dr.T.V.Rao MD 47

48. Hand Hygiene Techniques
Many Ways
1. Alcohol hand rub
2. Routine hand wash 10-15
seconds
3. Aseptic procedures 1 minute
4. Surgical wash 3-5 minutes
Dr.T.V.Rao MD' TMC Kollam Kerala 48

49. Dr.T.V.Rao MD
Risk Reduction: Antimicrobial
Pre-Operative Shower
Chlorhexidine Gluconate –
Primary choice
Iodophores
Hexachlorophene
49

50. Barrier Precautions
1. Gloves:
Disposable gloves must be worn when:
a) Direct contact with B/BF is expected.
b) Examining a lacerated or non-intact
skin e.g wound
dressing.
c) Examination of oropharynx, GIT, UIT
and dental procedures.
Dr.T.V.Rao MD 50

51. Barrier Precautions
d) Working directly with
contaminated instruments
or equipment.
e) HCW has skin cuts,
lesions and dermatitis
Sterile gloves are used for
invasive procedures.
GLOVES MUST BE of
good quality, suitable
size and material.
Never reused.
Dr.T.V.Rao MD 51

52. Barrier Precautions
•Masks & Protective eye wear:
• MUST BE USED WHEN: engaged in procedures likely
to generate droplets of B/BF or bone chips
• During surgical operations to protect wound from
staff breathings, …
• Masks must be of good quality, properly fixed on
mouth and nasal openings.
Dr.T.V.Rao MD 52

53. Barrier Precautions
• 3) Gowns/ Aprons:
• Are required when:
• Spraying or spattering of blood or body fluids is anticipated
e.g surgical procedures.
• Gowns must not permit blood or body fluids to pass through.
• Sterile linen or disposable ones are used for sterile
procedures.
Dr.T.V.Rao MD 53

54. What to do if exposed to blood / body fluids
•Puncture wounds should be washed
immediately and the wound should be caused to
bleed
•If skin contamination should occur, wash the
area immediately
•Splashes to the nose or mouth should be flushed
with water
Dr.T.V.Rao MD 54

55. If Exposed
•Eye splashes require irrigation with
clean water, saline, or a sterile irritant
•Most importantly: Complete a GBMC
Employee Incident Report. Report
exposure to charge nurse and Agency
immediately
Dr.T.V.Rao MD 55

56. Sharp precautions
• Needle stick and sharp injuries carry the risk of blood
born infection e.g AIDS, HCV,HBV and others.
• Sharp injuries must be reported and notified
•NEVER TO RECAP NEEDLES
• Dispose of used needles and small sharps
immediately in puncture resistant boxes (sharp
boxes).
Dr.T.V.Rao MD 56

57. Do not Recap Needles
A threat to LIFE
Dr.T.V.Rao MD 57

58. Protecting Yourself from Blood-Borne
Pathogens
Dr.T.V.Rao MD' TMC Kollam Kerala

59. Aseptic technique
•Sepsis - harmful infection by bacteria
•Asepsis - prevention of sepsis
•Minimise risk of introducing pathogenic
micro-organisms into susceptible sites
•Prevent transfer of potential pathogens
from contaminated site to other sites,
patients or staff
•Follow local policy of your hospital
Dr.T.V.Rao MD 59

60. Isolation
• Single room or group
• Source or protective
• Source - isolation of infected patient
• mainly to prevent airborne transmission via
respiratory droplets
• respiratory MRSA, pulmonary tuberculosis
• Protective - isolation of immune-suppressed
patient (May, 2000)
• Significant psychological effects (Davies et
al, 1999)
Dr.T.V.Rao MD 60

61. Linen handling and disposal
• Bed making and linen changing techniques
• Gloves and apron - handling contaminated
linen
• Appropriate laundry bags
• Avoid contamination of clean linen
• Hazards of on-site ward-based laundering
• NHS Executive guidelines (1995)
• Follow local policy of your hospital
Dr.T.V.Rao MD 61

62. Waste disposal
• Clinical waste - HIGH risk
• potentially/actually contaminated waste including
body fluids and human tissue
• yellow plastic sack, tied prior to incineration
• Household waste - LOW risk
• paper towels, packaging, dead flowers, other
waste which is not dangerously contaminated
• black plastic sack, tied prior to incineration
• Follow local policy of your Hospitals
Dr.T.V.Rao MD 62

63. Spillage of body fluids
• PPE - disposable gloves, apron
• Soak up with paper towels, kitchen roll
• Cover area with hypochlorite solution e.g., Milton,
for several minutes
• Clean area with warm water and detergent, then
dry
• Treat waste as clinical waste - yellow plastic sack
• Follow local policy (May, 2000)
Dr.T.V.Rao MD 63

64. Environmental cleaning
• Recent concern regarding poor hygiene in hospital
environments (NHSE, 1999)
• Some pathogens survive for long periods in dust,
debris and dirt
• Poor hygiene standards - hazardous to patients
and staff (May, 2000)
• Report poor hygiene to Domestic Services (UKCC,
1992)
• “Hospitals should do the sick no harm”
(Nightingale, 1854)
Dr.T.V.Rao MD 64

65. Risk assessment
• No risk of contact/splashing with blood/body
fluids - PPE not required
• Low or moderate risk of contact/splashing - wear
gloves and plastic apron
• High risk of contact/splashing - wear gloves,
plastic apron, gown, eye/face protection (Rcn,
1995)
• Cerebrospinal fluid, peritoneal fluid, pleural fluid,
synovial fluid, amniotic fluid, semen, vaginal
secretions, and
• Any other fluid containing visible blood e.g., urine,
faeces (Rcn, 1995) Dr.T.V.Rao MD 65

66. In spite many developments in medicine and asepsis hand washing still
the best solution
Hand hygiene is the simplest,
most effective measure for
preventing hospital-acquired
infections.
Dr.T.V.Rao MD 66

67. Dr.T.V.Rao MD 67

68. Ways to overcome the nosocomial infections
•Besides, hospitals need to have infection control
committees to conduct outcome and process
surveillance for nosocomial infections. This
committee should meet regularly and publish
the results of their surveillance. At the same
time, healthcare institutions should adopt new
and better technology, like closed system IV
fluids, in order to reduce the rates of infections.
Dr.T.V.Rao MD 68

69. Basic hygiene is key to control infections
• Ignaz Semmelweis in 1847 demonstrated
that washing hands saves lives
• Old bacteria are causing new problems
• New viral and prion diseases are causing
new problems
• Reluctance to wash hands still the single
most important cause of HAI (ICNA, 1998)
•Growing concern about poor
hospital hygiene
Dr.T.V.Rao MD 69

70. Nurses should be familiar with
Surveillance Activities
• Operative Procedures
• Critical Care Units (MICU,
SICU, NICU)
• Targeted Surveillance
• Outbreak Investigation

71. Benchmarking Hospital Acquired
Infections
•CDC’s Hospital Infections Program
•Submit monthly data on ICU infections
•Benchmarking with similar hospitals
•Networking opportunities
•Annual reports
•Start having a Infection Audit

72. Surveillance Data
Improves the Patient Safety
• USES
•Improve patient outcomes by
• modifying patient care
practices
• reducing length of stay
•Identify education needs
•Evaluate new products
•Identify new opportunities
for improvement

73. Nurses should Evaluate their Outcome
• MEASURE SUCCESS OF
INFECTION CONTROL
TECHNIQUES
• COMPARE PATIENT’S RESPONSE
TO ACTUAL OUTCOME
• WHAT WILL YOU DO IF
GOAL/OUTCOMES NOT
ACHIEVED?

74. Our Hands are Threat to LIFE
Just Washing can Save Many LIVES
Dr.T.V.Rao MD 74

75. Let us support our hospitals with clean hands
Dr.T.V.Rao MD 75

76. Soap Water and Common sense are Best Antiseptics-
William Osler
Dr.T.V.Rao MD' TMC Kollam Kerala 76

77. WE ARE ALL RESPONSIBLE
INFECTION CONTROL

78. I am thankful to every one at Kinder
Hospital Cherthala Alappuzha Kerala