Hospitalacquiredinfections 121216105351-phpapp02

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Hospitalacquiredinfections 121216105351-phpapp02

  1. 1. HOSPITAL ACQUIRED INFECTIONS Aarti Sareen MSPT Honours I Roll No. 8
  2. 2. Hospital acquired infection is also called Nosocomial infection or Healthcare-associated infections. "nosus" = disease "komeion" = to take care of Nosocomial infections can be defined as infection acquired by the person in the hospital, manifestation of which may occur during hospitalization or after discharge from hospital. The person may be a patient, members of the hospital staff and/ or visitors.
  3. 3. EPIDEMIOLOGICAL INTERACTION HOST FACTORS Suppresed immune system due to Age, Poor nutritional status, severity of underlying disease, complicated diagnostic & therapeutic procedure,therapeutic, THE AGENT Varieties of organisms Institutional and human Reservoirs & their virulence THE ENVIRNOMNET Everything that surrounds the patient in the hospital is his environment. Other patients Hospital staff and visitors Eatables Dust and other contaminated articles NCI
  4. 4. Endogenous/direct: Caused by the organisms that are present as part of normal flora of the patient Exogenous/indirect Caused by organisms acquiring by exposure to hospital personnel, medical devices or hospital environment, cross- infection from medical personnel • hospital environment- inanimate objects – air – dust – IV fluids & catheters – washbowls – bedpans – endoscopes – ventilators & respiratory equipment – water, disinfectants etc SOURCE OF INFECTION
  5. 5. EXOGENOUS INFECTION SITES
  6. 6. The Inanimate Environment Can Facilitate Transmission ~ Contaminated surfaces increase cross-transmission ~
  7. 7. Exogenours Pathogens
  8. 8. • Mid-1980’s – Enterobacteriaceae – S. aureus – P. aeruginosa • Mid-1990’s – Decline in Enterobacteriaceae – Increase in gram- positive cocci – Emergence of fungi – Recognition of viruses Nosocomial Infections: Changing Microbiology
  9. 9. Viruses Bacteria Fungi Parasites All microorganisms can cause nosocomial infections
  10. 10. Gram +ve Staphylococcus aureus Staphylococcus epidermidis Gram -ve Enterobacteriaceae Pseudomonas aeruginosa Acinetobacter baumanni Mycobacterium tuberculosis BACTERIA
  11. 11. Pseudomonas aeruginosa Enterococcus Coag-neg staphylococcl E-coli Staphylococcus aureus Other COMMON BACTERIAL AGENTS (9%) (10%) (11%) (12%) (13%) (45%)
  12. 12. Viruses ◦ Blood borne infections : HBV, HCV, HIV ◦ Others: rubella, varicella, SARS Fungi ◦ Candida ◦ Aspergillus
  13. 13. – Urinary tract infections (UTI) – Surgical wound infections (SWI) – Lower respiratory infections – Traumatic wounds and burns infections – Primary bacteraemia – Gastrointestinal tract – Central nervous system TYPES OF INFECTIONS
  14. 14. Major Types of Nosocomial Infections 0 5 10 15 20 25 30 35 Overall ICU UTI Pneumonia SWI Bloodstream Other Richards, MJ. 1999. Crit Care Med 27; 887.
  15. 15. Mode of trasmission Contact/hand borne (most common) Aerial route or air borne Oral route Parenteral route Vector borne
  16. 16. Direct (physical contact) – Hands & clothing – Droplet contact followed by autoinoculation – Clinical equipment Indirect via contaminated articles – Bedpans, – bowls, jugs, – Instruments like needles, – dressings, – contaminated gloves,etc. 1. Contact (most common)
  17. 17. 2. Airborne Transmission – Droplet respiratory secretions on surfaces – Inhalation of infectious particles e.g. (TB, Varicella) 3. Oral route 4. Parenteral route 5. Vector borne: through mosquitoes, flies, rats
  18. 18. Pathogens transmission
  19. 19. The hands are the most important vehicle of transmission of HCAI
  20. 20. Why Don’t Staff Wash their Hands (Compliance estimated at less than 50%)
  21. 21. 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)
  22. 22. Hand Hygiene Techniques 1. Alcohol hand rub 2. Routine hand wash 10-15 seconds 3. Aseptic procedures 1 minute 4. Surgical wash 3-5 minutes
  23. 23. Repeat procedures until hands are clean Routine Hand Wash
  24. 24. Areas Most Frequently Missed HAHS © 1999
  25. 25. Hand Care • Nails • Rings • Hand creams • Cuts & abrasions • “Chapping” • Skin Problems
  26. 26. Hand hygiene is the simplest, most effective measure for preventing hospital-acquired infections.
  27. 27. Surveillance
  28. 28. Why surveillance? • NCI cause of morbidity and mortality • One third may be preventable • Surveillance = key factor – an infection control measure – overview of the burden and distribution of NCI – allocate preventive resources • Surveillance is cost-efficient!!
  29. 29. Objectives • Reducing infection rates • Establishing endemic baseline rates • Identifying outbreaks • Identifying risk factors • Persuading medical personnel • Evaluate control measures • Satisfying regulators • Document quality of care • Compare hospitals’ NCI rates
  30. 30. The surveillance loop Event Action Data Information Health care system Surveillance centre Reporting Feedback, recommendations Analysis, interpretation
  31. 31. Considerations when creating a surveillance system • Goal of the surveillance system (why) • Engage the stakeholders (who) • Surveillance method (what, how, when) – definition – what to collect – how to collect (operation of system) • Available resources
  32. 32. Who • All hospitals? • All departments? • All specialties? • Other health institutions?
  33. 33. ….. Public Health instituteI Directorat Ministry Of health Service dep. Lab Patients Surgical ward. 2 Surgical wards It- dep. ICP Local adm. Central adm. Surveillance of surgical site infections Stakeholders
  34. 34. Control of NCI
  35. 35. There are three principal goals for hospital infection control and prevention programs: 1. Protect the patients 2. Protect the health care workers, visitors, and others in the healthcare environment. 3. Accomplish the previous two goals in a cost effective and cost efficient manner, whenever possible. . Goals for infection control and hospital epidemiology
  36. 36. To control the nosocomial infection we need to consider the chain of infection and the transmission of an infectious agent
  37. 37. – observance of aseptic technique – frequent hand washing especially between patients – careful handling, cleaning, and disinfection of fomites – where possible use of single-use disposable items – patient isolation – avoidance where possible of medical procedures that can lead with high probability to nosocomial infection (urinary catheter) Prevention & control of nosocomial infections
  38. 38. – Various institutional methods such as air filtration within the hospital – Appropriate isolation precautions to protect patients, visitors, and HCWs. – Surveillance for common infections, monitoring of high risk patients, and hospital area to identify outbreaks, document incidence and prevalence rate of specific infections and set goal for improvement. Prevention & control of nosocomial infections (cont.)
  39. 39. Uttermost care should be taken in following services: • House keeping • Dietary services • Linen and laundry • Central sterile supply department • Nursing care • Waste disposal • Antibiotic policy • Hygiene and sanitation
  40. 40. The 5 pillars of infection control Isolation&barrierprecautions Decontaminationofequipment Prudentuseofantibiotics Handwashing Decontaminationofenvironment
  41. 41. Infection Control Committee
  42. 42. Infection control Committee (ICC): The hospital ICC is charged with the responsibility for the planning, evaluation of evidenced-based practice and implementation, prioritization and resource allocation of all matters relating to infection control.
  43. 43. Infection Control Team Infection Control Nurse (ICN)Infection Control Doctor (ICD)
  44. 44. Role of infection control teams • Education and training • Development and dissemination of infection control policy • Monitoring and audit of hygiene • Clinical audit

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