Hospital acquired     infection
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Hospital acquired infection

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Hospital acquired     infection Hospital acquired infection Presentation Transcript

  • BY; Kashif Nadeem Khokhar January, 30, 2013
  • 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.
  • 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.
  • 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.
  • 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.
  • 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 ).
  • 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.
  • 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.
  • HOSPITAL ACQUIRED INFECTIONS
  • 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.
  • 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.
  • 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.
  • 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.
  • BACTERIAL AND VIRAL AGENTS
  • Bacterial Agents  Multiple-Resistant Organisms, such as  Vancomycin-Resistant S. aureus, and  Inducible or Extended-Spectrum Betalactamase Gram-Negative Organisms Are Constant Threat.
  • 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.
  • Facts & Figures
  • 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.
  • 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%
  • 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%
  • THANK YOU SO MUCH…!!!!!  Kashif Nadeem Khokhar