BY; Kashif Nadeem Khokhar
January, 30, 2013
Hospital acquired infection

•

 are generally
Hospital Acquired Infections

known as Nosocomial Infections or Health-car...
PATHOPHYSIOLOGY


 Risk Factors for invasion of pathogens are categorized
into 3 Areas, Iatrogenic, Organizational, and ...
CLINICAL CAUSES


 HAI are caused by Viral, Bacterial and Fungal pathogens.
 During Hospital Stay, many patients acquir...
SIGNS AND SYMPTOMS


Fever, Tachycardia, Skin Rash, General Malaise
can be Physical signs and symptoms.
Instrumentation...
MOST COMMON HOSPITAL
ACQUIRED INFECTIONS



 Candidiasis
 Colitis
 Endocarditis (Bacterial & Fungal)
 Enteroviral Inf...
DIAGNOSIS


 A detailed Physical Examination (PE) and Review of the
systems, Reveal the involved Organs & Systems.
 Stu...
TREATMENT



Medical Care;

Symptomatic Treatment for Shock, Hypoventilation and other Complications is
provided, Along...
HOSPITAL
ACQUIRED
INFECTIONS
BLOOD-STREAM INFECTIONS


Broad-Spectrum Antibiotics should be
Selected according to the Microbial
Susceptibility.
Anti...
PNEUMONIA


Broad-Spectrum Antibiotics are used.
Macrolide Antibiotics are indicated in
Legionellosis.
Antivirals (e.g...
URINARY TRACT
INFECTIONS ( UTI )



Indwelling Catheters should be
Removed, if Feasible.
Empiric Antibiotic and Antifun...
CONSULTATIONS


Many Nosocomial Infected patients
require Expert Care from an ICU Team.
Infectious Disease Specialists,...
BACTERIAL AND VIRAL
AGENTS
Bacterial Agents

Multiple-Resistant Organisms, such as
 Vancomycin-Resistant S. aureus, and
 Inducible or Extended-Sp...
VIRAL AGENTS

The Rapid spread of Respiratory
Syncytial Virus ( RSV ) among Pediatric
Patients during an RSV Epidemic,
p...
Facts & Figures
FREQUENCY

In United States, Hospital Acquired
Infections are Estimated to occur in 5%
of all Acute Hospitalizations.
T...
SURVEY REPORT



 Among 6,290 Pediatric Patients Surveyed between
1992-1997, The Incidence of HAI were as Follows,

 Bl...
LATEST SURVEY



 In Ireland, 3,992 in-patients across 16 acute and local Hospitals
were Surveyed in 2012.
 Overall onl...
THANK YOU SO
MUCH…!!!!!


Kashif Nadeem Khokhar
Hospital acquired     infection
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Hospital acquired infection

  1. 1. BY; Kashif Nadeem Khokhar January, 30, 2013
  2. 2. Hospital acquired infection •  are generally Hospital Acquired Infections known as Nosocomial Infections or Health-care Associated Infections (HAI). • HAI do NOT originate from patient’s original diagnosis. • Infections that become clinically evident, 48 Hours after hospitalization are called HAI. • If infections are acquired during hospitalization but become evident after discharge, they are said to have Nosocomial Origin.
  3. 3. PATHOPHYSIOLOGY   Risk Factors for invasion of pathogens are categorized into 3 Areas, Iatrogenic, Organizational, and patient related.  Iatrogenic RF include, Pathogens present on Medical Personnel hands, Invasive Procedures (e.g. intubation, urine catheterization) and Antibiotic use and prophylaxis.  Organizational RF include contaminated air-conditioning and water system, and staffing and physical layout of the facility. (e.g. Nurse-to-patient ratio, open bed distance).  Patient RF include, severity of illness, underlying immuno-compromised state, and Length of the stay.
  4. 4. CLINICAL CAUSES   HAI are caused by Viral, Bacterial and Fungal pathogens.  During Hospital Stay, many patients acquire Rotaviral infections and Viral Respiratory infections in Winter, (e.g. Influenza). And Enteroviral infections in Summer.  Viruses are Responsible for up to 14% of HAI, with Identifiable pathogens in Pediatric Patients.  Bacterial and Fungal infections are less Common.  Bacterial infections are mostly caused while placing Intravascular lines and Urinary Catheters.  Fungal infections mostly arise from Patient’s own Flora.
  5. 5. SIGNS AND SYMPTOMS  Fever, Tachycardia, Skin Rash, General Malaise can be Physical signs and symptoms. Instrumentation is a most common source of HAI, Endotracheal Tube may be Associated with Sinusitis, Tracheitis and Pneumonia. Intravascular Catheter may be source of Phlebitis or line infection.
  6. 6. MOST COMMON HOSPITAL ACQUIRED INFECTIONS   Candidiasis  Colitis  Endocarditis (Bacterial & Fungal)  Enteroviral Infections  Hepatitis C  Influenza  Legionella Infections  Toxic Shock Syndrome  Pseudomonas Infections  Rhinovirus Infections  Urinary Tract Infections ( UTI ).
  7. 7. DIAGNOSIS   A detailed Physical Examination (PE) and Review of the systems, Reveal the involved Organs & Systems.  Study should be centered on Infections of Bloodstream , UTI, and Pneumonia, unless, An Obvious Source (e.g. Surgical-Site infection) is readily Identified.  Blood cultures, Radiography, Sputum Culture, Gram staining, Acid-Fast Staining, Fungal Cultures, and Viral Cultures can be helpful for diagnosing HAI.  Special Imaging Techniques (e.g. Sonography, CT, or MRI) can be helpful in Evaluating Obscure Site Infections.
  8. 8. TREATMENT  Medical Care; Symptomatic Treatment for Shock, Hypoventilation and other Complications is provided, Along with the Administration of Empiric Broad Spectrum Antimicrobials, Antifungals and Antivirals.
  9. 9. HOSPITAL ACQUIRED INFECTIONS
  10. 10. BLOOD-STREAM INFECTIONS  Broad-Spectrum Antibiotics should be Selected according to the Microbial Susceptibility. Antifungals (e.g. Fluconazole) can be added to Empiric Antibiotics in Some Cases. Antivirals (e.g. Acyclovir) can be used for Viral Infections.
  11. 11. PNEUMONIA  Broad-Spectrum Antibiotics are used. Macrolide Antibiotics are indicated in Legionellosis. Antivirals (e.g. Amantadine, and Rimantadine) are used for Viral Pneumonia, ( for patients over age 1 year ). The most Cost-Effective Prevention measure is Vaccination against Influenza A and B.
  12. 12. URINARY TRACT INFECTIONS ( UTI )  Indwelling Catheters should be Removed, if Feasible. Empiric Antibiotic and Antifungal Therapy, based on Results of Urinalysis and Urine Gram Staining.
  13. 13. CONSULTATIONS  Many Nosocomial Infected patients require Expert Care from an ICU Team. Infectious Disease Specialists, BurnCare Specialists, And Surgical Teams, Usually are involved in the care of These Complicated Cases.
  14. 14. BACTERIAL AND VIRAL AGENTS
  15. 15. Bacterial Agents  Multiple-Resistant Organisms, such as  Vancomycin-Resistant S. aureus, and  Inducible or Extended-Spectrum Betalactamase Gram-Negative Organisms Are Constant Threat.
  16. 16. VIRAL AGENTS  The Rapid spread of Respiratory Syncytial Virus ( RSV ) among Pediatric Patients during an RSV Epidemic, poses a Threat to Children, Who Require Hospitalization during Winter Months.
  17. 17. Facts & Figures
  18. 18. FREQUENCY  In United States, Hospital Acquired Infections are Estimated to occur in 5% of all Acute Hospitalizations. The highest Rates of infection occurs in The Burn ICU, Neonatal ICU, and Pediatric ICU. Mortality Rate is about 90,000 deaths per Year in USA due to HAI.
  19. 19. SURVEY REPORT   Among 6,290 Pediatric Patients Surveyed between 1992-1997, The Incidence of HAI were as Follows,  Bloodstream Infections, 28%  Ventilator Associated Pneumonia, 21%  Urinary Tract Infections ( UTI ), 15%  Lower Respiratory Infections, 12%  GI, Skin, Soft Tissue and CV Infections, 10%  Surgical Site Infections, 7%  ENT Infections, 7%
  20. 20. LATEST SURVEY   In Ireland, 3,992 in-patients across 16 acute and local Hospitals were Surveyed in 2012.  Overall only 4.2% Patients had HAI.  Respiratory Infections, 27.9%  Surgical Site Infections, 18.9%  Urinary Tract Infections, 11.8%  Patients taking more than 1 Antibiotic, 10.9%  Overall Use of Antibiotics for HAI, 18.3%
  21. 21. THANK YOU SO MUCH…!!!!!  Kashif Nadeem Khokhar
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