HOSPITAL ACQUIRED    (NOSOCOMIAL)  INFECTIONMahboob Ali Khan MHA CPHQ USA Harvard
DEFINITION:ANY INFECTION ACQUIRED BY APATIENT IN HOSPITAL.
SOME STATISTICS:•   Affects approx. 10% of all in-patients•   (KFHUrate the last 5 years 1.14%)•   delays discharge•   HAI...
SOURCES:1.Patients own flora - Endogenous (50%)                                   Auto-Infection ( Greatest source of pote...
Classification of surgical proceduresCleanno entry into GI/GU/Resp tractlow riskinfection usually exogenousClean contamina...
IMPORTANT CROSS-INFECTION       ORGANISMS
METHICILLIN RESISTANT STAPHAUREUS (MRSA)Resistant to Flucoxacillin and usually othersMay cause -     Wound infection     B...
Colonisation common:     Nose Axilla Perineum     Wounds/LesionsSpread By:     Hands     Fomites     Aerosols     Becoming...
TUBERCULOSISOpen pulmonary TB (Sputum smear positive forAFB)VIRAL INFECTIONSChicken Pox(Hepatitis B HIV)
RESISTANT GRAM NEGATIVEORGANISMSResistance to multiple antibioticsOrganisms:     E .coli     Proteus     Enterobacter     ...
Cause:BacteraemiaU.T.I.PneumoniaWound infectionControl:Antibiotic PolicyControl of Infection GuidelinesPrevention of Cross...
SURVEILLANCEImportant means of monitoring HAIEarly detection of trends outbreaks1. Laboratory BasedMicrobiology Laboratory...
H.A.I. IS INCREASING:• compromised patients• ward and inter-hospital transfers• antibiotic resistance (MRSA, resistant Gra...
Many Personnel Don’t Realize            WhenThey Have Germs on Their Hands• Healthcare workers can get 100s to 1000s of  b...
GENERAL PRINCIPLESGood general ward hygiene:     - No overcrowding     - Good ventilation     - Regular removal of dust   ...
WhyDon’t Staff Wash  their Hands(Compliance estimated at less than 50%)
Why Not?•   Skin irritation•   Inaccessible hand washing facilities•   Wearing gloves•   Too busy•   Lack of appropriate s...
Why Not?•   Working in high-risk areas•   Lack of hand hygiene promotion•   Lack of role model•   Lack of institutional pr...
Successful Promotion • Education• Routine observation & feedback• Engineering controls   – Location of hand basins   – Po...
Successful Promotion • Reminders in the workplace• Promote and facilitate skin care• Avoid understaffing and excessive  w...
Hand HygieneEasy, timely access to both hand hygieneand skin protection is necessary forsatisfactory hand hygiene.A study ...
Hand Hygiene Techniques1. Alcohol hand rub2. Routine hand wash 10-15 seconds3. Aseptic procedures 1 minute4. Surgical wash...
Routine Hand WashRepeat procedures until hands are clean
Alcohol Hand Rubs•   Require less time•   Can be strategically placed•   Readily accessible•   Multiple sites•   All patie...
Alcohol Hand Rubs•   Acts faster•   Excellent bactericidal activity•   Less irritating (??)•   Sustained improvement
Alcohol Hand RubsChoose agent carefully:  – Adequate antimicrobial efficacy  – Compatibility with other hand    hygiene pr...
Visible soilingHands that are visibly soiled orpotentially grossly contaminatedwith dirt or organic materialMUST by washed...
Areas Most Frequently Missed             HAHS © 1999
Hand Care• Nails• Rings• Hand creams• Cuts & abrasions• “Chapping”• Skin Problems
Hand hygiene is thesimplest, most effectivemeasure for preventing   hospital-acquired      infections.
PREVENTING CROSS INFECTIONIf known or suspected on admission to hospital, ordetected following admission:      -   Isolati...
Any Questions???• Thank you for not asking!!!
tHanK YoU fOr yoUr cOopeRatiO     and UnTiriNg sUPpoRt
Hospital acquired (nosocomial) infection by Mahboob ali khan CPHQ USA
Hospital acquired (nosocomial) infection by Mahboob ali khan CPHQ USA
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Hospital acquired (nosocomial) infection by Mahboob ali khan CPHQ USA

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Nosocomial infections are commonly transmitted when hospital officials become complacent and personnel do not practice correct hygiene regularly. Also, increased use of outpatient treatment in recent decades means that a greater percentage of people who are hospitalized today are likely to be seriously ill with more weakened immune systems than in the past. Moreover, some medical procedures bypass the body's natural protective barriers. Since medical staff move from patient to patient, the staff themselves serve as a means for spreading pathogens. Essentially, the staff act as vectors.

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  • Nosocomial infections are commonly transmitted when hospital officials become complacent and personnel do not practice correct hygiene regularly. Also, increased use of outpatient treatment in recent decades means that a greater percentage of people who are hospitalized today are likely to be seriously ill with more weakened immune systems than in the past. Moreover, some medical procedures bypass the body's natural protective barriers. Since medical staff move from patient to patient, the staff themselves serve as a means for spreading pathogens. Essentially, the staff act as vectors.
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  • Hand out article and ask participants to get into small groups and select 5 most common reasons they do not was hands from the reasons listed in the article – table 2 and list any other reasons they might think of in their own agencies. 5 – 10 minutes Discuss each groups list and collate list on white board Mark off those that repeat – number list in order of most common (1) to least common (2) Ask for other reasons group have come up with – list on board
  • Routine hand wash 10 – 15 seconds using a neutral pH soap Before eating or smoking. After going to the toilet Before significant patient contact Before injection, venepuncture Before and after routine use of gloves After handling items soiled with blood or body substances Aseptic procedures One minute using an antimicrobial soap or skin cleanser Before any nonsurgical procedures that require aseptic technique (such as inserting IV catheters) Surgical wash First wash – 5 minutes Subsequent washes – 3 minutes using an antimicrobial skin cleaner containing 4% chlorhexidine or povidone-iodine Before any invasive surgical procedure Non-water cleansers or antiseptic products such as alcohol-based hand rubs or foam may be used when hand washing facilities are inadequate or in emergency situations where there may be insufficient time and/or facilities. If hands are visibly soiled a source of water should be sought. Hands should be washed as soon as an appropriate facilities become available. Add Notes Here:
  • Note: Hand and wrist jewellery including plain weddings bands should not be worn, as these are likely to increase the presence of gram negative bacilli Nails should be short and clean and artificial nails should be discouraged as they contribute to increased bacterial counts. Wet hands thoroughly with warm running water. Keep hands lower than elbows and apply soap. Use friction to clean between fingers, palms, backs of hands and wrists. 4. Rinse hands under running water until all soap is gone. DO NOT TOUCH TAPS WITH CLEAN HANDS – IF ELBOW OR FOOT CONTROLS ARE NOT AVAILABLE, USE PAPER TOWEL TO TURN TAPS OFF. 5. Pat hands dry with a clean, single use towel. A neutral soap should be used for routine handwashing. If liquid soap is dispensed from reusable containers, these must be cleaned when empty and dried before refilling with fresh soap – refilling soap containers is a potential source of infection. Where possible single use soap containers or bladders should be used. HANDWASH SOLUTIONS SHOULD NEVER BE TOPPED UP Scrub brushes should not be used for routine handwashing because they can cause abrasion of the skin, and may be a source of infection. Add Notes Here:
  • Hospital acquired (nosocomial) infection by Mahboob ali khan CPHQ USA

    1. 1. HOSPITAL ACQUIRED (NOSOCOMIAL) INFECTIONMahboob Ali Khan MHA CPHQ USA Harvard
    2. 2. DEFINITION:ANY INFECTION ACQUIRED BY APATIENT IN HOSPITAL.
    3. 3. SOME STATISTICS:• Affects approx. 10% of all in-patients• (KFHUrate the last 5 years 1.14%)• delays discharge• HAI costs 2times >no infection• direct cause deathsSocio-economic burden of HAI
    4. 4. SOURCES:1.Patients own flora - Endogenous (50%) Auto-Infection ( Greatest source of potential danger)2.Environment - Exogenous(15%) (Air-5%; Instruments-10%)3.Another Patient/Staff - Cross Infection (35%)
    5. 5. Classification of surgical proceduresCleanno entry into GI/GU/Resp tractlow riskinfection usually exogenousClean contaminatedno significant spillagee.g. cholecystectomyinfection rates 5-10 %ContaminatedSignificant spillage of bacteria expected Infection rate 18-20%DirtyPerforated viscus drainage ofabscess Infection rate often >30%
    6. 6. IMPORTANT CROSS-INFECTION ORGANISMS
    7. 7. METHICILLIN RESISTANT STAPHAUREUS (MRSA)Resistant to Flucoxacillin and usually othersMay cause - Wound infection Bacteraemia Skin/soft tissue infection U.T.I. Pneumonia etc.
    8. 8. Colonisation common: Nose Axilla Perineum Wounds/LesionsSpread By: Hands Fomites Aerosols Becoming more common in the CommunityControl: Eradication of carriage Barrier nursing Screening of other patients Staff
    9. 9. TUBERCULOSISOpen pulmonary TB (Sputum smear positive forAFB)VIRAL INFECTIONSChicken Pox(Hepatitis B HIV)
    10. 10. RESISTANT GRAM NEGATIVEORGANISMSResistance to multiple antibioticsOrganisms: E .coli Proteus Enterobacter Acinetobacter Pseudomonas aeruginosa
    11. 11. Cause:BacteraemiaU.T.I.PneumoniaWound infectionControl:Antibiotic PolicyControl of Infection GuidelinesPrevention of Cross Infection especially on high riskareas
    12. 12. SURVEILLANCEImportant means of monitoring HAIEarly detection of trends outbreaks1. Laboratory BasedMicrobiology Laboratory lists +ve organismsICN reviews ‘Alert organisms’ reported2. Ward BasedWard staff monitor patientsICN reviews ICN visits wards
    13. 13. H.A.I. IS INCREASING:• compromised patients• ward and inter-hospital transfers• antibiotic resistance (MRSA, resistant Gram negatives)• increasing workload • staff pressures • lack of facilities • ? lack of concern HAI is inevitable but some is preventable (irreducible minimum) • realistically reducible by 10-30%
    14. 14. Many Personnel Don’t Realize WhenThey Have Germs on Their Hands• Healthcare workers can get 100s to 1000s of bacteria on their hands by doing simple tasks like: – pulling patients up in bed – taking a blood pressure or pulse – touching a patient’s hand – rolling patients over in bed – touching the patient’s gown or bed sheets – touching equipment like bedside rails, overbed tables, IV pumps Casewell MW et al. Br Med J 1977;2:1315 Ojajarvi J J Hyg 1980;85:193
    15. 15. GENERAL PRINCIPLESGood general ward hygiene: - No overcrowding - Good ventilation - Regular removal of dust - Wound dressing early in day - Disposable equipment HAND WASHING most important - Before and after patient contact before invasive procedures
    16. 16. WhyDon’t Staff Wash their Hands(Compliance estimated at less than 50%)
    17. 17. Why Not?• Skin irritation• Inaccessible hand washing facilities• Wearing gloves• Too busy• Lack of appropriate staff• Being a physician (“Improving Compliance with Hand Hygiene in Hospitals” Didier Pittet. Infection Control and Hospital Epidemiology. Vol. 21 No. 6 Page 381)
    18. 18. Why Not?• Working in high-risk areas• Lack of hand hygiene promotion• Lack of role model• Lack of institutional priority• Lack of sanction of non-compliers
    19. 19. Successful Promotion • Education• Routine observation & feedback• Engineering controls – Location of hand basins – Possible, easy & convenient – Alcohol-based hand rubs available• Patient education (Improving Compliance with Hand Hygiene in Hospitals. Didier Pittet. Infection Control and Hospital Epidemiology. Vol. 21 No. 6 Page 381)
    20. 20. Successful Promotion • Reminders in the workplace• Promote and facilitate skin care• Avoid understaffing and excessive workload; Nursing shortages have caused
    21. 21. Hand HygieneEasy, timely access to both hand hygieneand skin protection is necessary forsatisfactory hand hygiene.A study by Pittet showed a 20% increase incompliance by using feedback andencouraging the use of alcohol hand rubs
    22. 22. Hand Hygiene Techniques1. Alcohol hand rub2. Routine hand wash 10-15 seconds3. Aseptic procedures 1 minute4. Surgical wash 3-5 minutes
    23. 23. Routine Hand WashRepeat procedures until hands are clean
    24. 24. Alcohol Hand Rubs• Require less time• Can be strategically placed• Readily accessible• Multiple sites• All patient care areas
    25. 25. Alcohol Hand Rubs• Acts faster• Excellent bactericidal activity• Less irritating (??)• Sustained improvement
    26. 26. Alcohol Hand RubsChoose agent carefully: – Adequate antimicrobial efficacy – Compatibility with other hand hygiene products
    27. 27. Visible soilingHands that are visibly soiled orpotentially grossly contaminatedwith dirt or organic materialMUST by washed with liquidsoap and water
    28. 28. Areas Most Frequently Missed HAHS © 1999
    29. 29. Hand Care• Nails• Rings• Hand creams• Cuts & abrasions• “Chapping”• Skin Problems
    30. 30. Hand hygiene is thesimplest, most effectivemeasure for preventing hospital-acquired infections.
    31. 31. PREVENTING CROSS INFECTIONIf known or suspected on admission to hospital, ordetected following admission: - Isolation (barrier precautions) - Inform Infection Control team - Treatment - if appropriate - Regular surveillance
    32. 32. Any Questions???• Thank you for not asking!!!
    33. 33. tHanK YoU fOr yoUr cOopeRatiO and UnTiriNg sUPpoRt
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