Aim is to present this disease as a very important problem of India and the world, though it is under looked upon

1. HOSPITAL ACQUIRED
INFECTIONS
DEPARTMENT OF COMMUNITY
MEDICINE
MODERATED BY: DR DHIRAJ SRIVASTAVA
PRESENTED BY:
SANCHITA SAINI
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2. DEFINITION
• Infections that develop within a hospital or
are produced by microorganisms,acquired
during hospitalization, within 48hrs.
• Also called as “NOSOCOMIAL INFECTIONS.”
• ‘Nosus’ means disease.
• ‘Kameion’ means to take care of.

3. DEFINITION BY
C.D.C
Infections that the patients
acquire during the course of
receiving treatment for other
conditions, or acquired by the
Healthcare Workers while
performing their duties in
healthcare settings.

4. HOST FACTORS
THE AGENT
EPIDEMIO-
LOGICAL
INTERACT-
ION
ENVIRONMENT

5. SOURCES OF
INFECTION
2 SOURCES :
EXOGENOUS
•Outside the human
body
ENDOGENOUS
•By Normal human
flora

6. •Caused by organisms
acquired by exposure to
hospital personnel,
medical devices or
hospital environment.
EXOGENOUS
INFECTIONS
•Caused by organisms
that are present as a part
of normal flora of the
patient.
ENDOGENOUS
INFECTIONS

9. SURGICAL SITE
INFECTIONS
• Any purulent discharge, abscess,
or spreading cellulitis at the
surgical site during the month
after the operation.
• The infection is usually acquired
during the operation itself; either
exogenously (e.g. from the air,
medical equipment, surgeons and
other staff), endogenously from
the flora on the skin or in the
operative site or, rarely, from
blood used in surgery

10. URINARY TRACT
INFECTIONS
 Positive urine culture (1 or 2
species) with at least 105
bacteria/ml, with or without
clinical symptoms.
 MOST COMMON
NOSOCOMIAL INFECTION
 80% of infections are
associated with the use of an
indwelling bladder catheter

11. RESPIRATORY
INFECTION
• Respiratory symptoms with
at least two of the following
signs appearing during
hospitalization:
 Cough
 Purulent sputum
 New infiltrate on chest
radiograph consistent with
infection.

12. BLOOD STREAM
INFECTIONS
 Represent a small
proportion of nosocomial
infections.
 Case fatality : >50%
 Organisms involved :
o Multi resistant coagulase-
negative Staphylococcus
o Candida spp.

13. MODES OF
TRANSMISSION
ROUTES OF
SPREAD
CONTACT AIR BORNE EXOGENOUS

14. CONTACT
TRANSMISSION
(MOST COMMON MODE OF TRANSMISSION)
CONTACT
DIRECT INDIRECT
HANDS,
AUTOINOCULATION,
EQUIPMENT.
BEDPANS,DRESSINGS,
CONTAMINATED
GLOVES

15. AIR BORNE
TRANSMISSION
• DROPLET NUCLEI IN THE
ATMOSPHERE
• RESPIRATORY SECRECTIONS
ON SURFACE (FOMITES)

16. EXOGENOUS INFECTIONS
SITES
IN HOSPITAL-INFECTIONS

17. STATUS IN INDIA
RISK OF INFECTION High in India.
• Approx. 19,900 neonatal deaths/year due to sepsis.
• 5-10% of patients admitted to acute care hospitals
acquire infections.
• 2 million patients/year affected.
• 90,000 deaths/year
• 1/4th of nosocomial infections occur in ICUs.
• 70% are due to antibiotic resistant organisms

18. PREVENTING
NOSOCOMIAL
INFECTIONS

19. ISOLATION
• Infectious patients MUST be isolated.
• Patients susceptible to infection should not be
placed in the beds next to patients who are a
source of infection.

20. MEASURES BY
HOSPITAL STAFF
• Those suffering from infectious ailments should be
kept away from work until completely cured.
• They should be careful about PERSONAL HYGIENE.
• Aprons & Outer clothing should be regularly
changed.

21. HAND WASHING

22. HAND HYGIENE
HANDS ARE THE MOST IMPORTANT VEHICLES
OF HAI TRANSMISSION
• THOUSANDS OF PEOPLE DIE EVERYDAY FROM INFECTIONS
WHILE RECEIVING HEALTH CARE
• MOST IMPORTANT MEASURE TO AVOID THE
TRANSMISSION OF HARMFUL MICROORGANISMS.
ANY HEALTHCARE WORKER/PERSON
INVOLVED IN DIRECT/INDIRECT PATIENT CARE
WHY?
WHO?

24. WHY DON’T STAFF WASH
HANDS?
• THE COMPLIANCE ESTIMATED IS LESS THAN 50%
• SKIN IRRITATION
• WEARING GLOVES
• TOO BUSY FOR REGULAR HAND WASHING
• LACK OF APPROPRIATE STAFF

25. DUST CONTROL
• Dust is released during SWEEPING, DUSTING &
BEDMAKING.
• Suppression by WET DUSTING
VACUUM CLEANING

26. PROPER DISPOSAL OF
HOSPITAL WASTE
COLOR WASTE TREATMENT
YELLOW Human & animal anatomical
waste/Microbiology waste and soiled
cotton/dressings/linen/bedding etc.
INCINERATION/ DEEP
BURIAL
RED Tubing/catheters/i.v. sets etc. AUTOCLAVE/MICRO
WAVE/CHEMICAL
TREATMENT
BLUE/
WHITE
Waste sharps
(needles,syringes,scalpels,blades etc.)
AUTOCLAVE/MICRO
WAVE/CHEMICAL
TREATMENT/
DESTRUCTION
BLACK Discarded medicines/
cytotoxic drugs/incineration
ash/chemical waste
DISPOSAL IN LAND
FIELDS

27. DISINFECTION
• Disinfection prevents transmission of organisms
between patients.
• LEVELS OF DISINFECTION:
o HIGH LEVEL - destroys all the microorganisms except heavy
contamination by bacterial spores.
o INTERMEDIATE LEVEL – inactivates M.tuberculosis, vegetative
bacteria, most viruses & fungi.
o LOW LEVEL – kills most bacteria, some viruses & some fungi.

28. STERILISATION
• Operationally, defined as decrease in microbial
load to 10-4.
• Done for
o Medical devices penetrating sterile body sites
o Parenteral fluids
o Medications
o Reprocessed equipment
• The objects must be wrapped after sterilization to
maintain its viability for longer durations of time.

29. CONTROL OF DROPLET
INFECTION
 Use of face-mask
 Proper bed-spacing
 Prevention of overcrowding
 Ensure adequate ventilation

30. IMPROVING NURSING
TECHNIQUES
• BARRIER NURSING is the effective measure.
• Its Aim is to protect medical staff against infection
by patients, especially with highly infectious
diseases.

31. ADMINISTRATIVE
MEASURES
• Formation of a hospital “CONTROL OF INFECTION
COMMITTEE” to formulate the policies regarding
admission of infectious cases, isolation facilities &
disinfection procedures.
• Formation of a CSSD (Central Sterile Supply
Department) in every hospital.

32. STANDARDS TO BE
MAINTAINED IN
HOSPITAL

33. • An attempt should be made to achieve and
maintain an average count of 10-15
bacteria/cubic foot of air in hospital.
• Less than 5 bacteria/cubic foot – minimal
risk of infection.
• More than 35 bacteria/cubic foot – high risk
of infection

34. Guideline to evaluate the
floor cleaning procedure
(based on R.O.D.A.C plate count)
• 0-25 bacteria/cubic foot - good floor cleaning
procedure.
• 26-50 bacteria/cubic foot – satisfactory.
• >50 bacteria/cubic foot – not satisfactory.

35. C.S.S.D
• Supply of sterile instrument & material for dressing &
procedure carried out in the wards and
departments.
• Sterilization of instruments & linen for use in O.T.
• Disinfection & Sterilization of medical equipment.
• Selection & distribution of single use sterile supplies
such as catheters, suction tubes, syringes.

36. C.S.S.D OF UPRIMS&R,
SAIFAI

37. MANUAL STEAM
STERILIZER

38. SEMI-AUTOMATIC
STEAM STERILIZER

39. AUTOMATIC STEAM
STERILIZER

40. ETO(ETHYLENE
TRIOXIDE) STERILIZER

41. WASHER
DISINFECTOR

42. ULTRASONIC
CLEANER

43. GLOVE WASHER

44. GLOVE DRYER

45. GLOVE POWDERING
MACHINE

46. BIBLIOGRAPHY
• Park’s Textbook of Preventive & Social Medicine 23rd
edition
• Bennett and Brachman’s Hospital Acquired Infections by
William R. Jarvis
• Hospital Administration by Francis & de ’Souza
• Prevention of Hospital Acquired Infections WHO
GUIDELINES
• CDC – www.cdc.gov/cdc.htm
• CSSD of UPRIMS&R, Saifai, Etawah – 206130

47. THANK YOU