HOSPIAL ACQUIRED INFECTION(DEPARTMENT OF COMMUNITY MEDICINE) Moderated by- Dr. Dhiraj Srivastava Presented by- Srihari Adhikari Roll No.- 73 Batch- 2010
Definition• Hospital acquired infection / nosocomial infection are infection acquired during hospital care which are not present or incubating at admission.• Infection occurring more than 48 hours after admission are usually considered nosocomial.
• Word Nosocomial comes from the greek word nosokomeion meaning hospital (nosos= disease, komeo= to take care of)
Definition by CDC• Infection that patients acquire during the course of receiving treatment for other conditions or that health workers acquire while performing their duties within healthcare setting
Surgical site infection• Any purulent discharge or abscess or spreading cellulitis at the surgical site during the month after the operation.
Urinary infection• Positive urine culture (1 or 2 species) with at least 1o thousand bacteria/ml without clinical symptoms.
Respiratory infection Respiratory symptoms with at least 2 of the following signs appearing during hospitalization• Cough• Purulent sputum• New infiltrate on chest radiograph consistent with infection.
septicaemia• Fever or rigors and at least one positive blood culture
Vascular catheter infection• Inflammation, lymphangitis or purulent discharge at the insertion site of the catheter
Prospective study in burn unit of a tertiary case referral centre in north india• Hospital wide study is Performed by Taneja N., Emmanuel R.,Chari P S, Sharma M. in 2004• 71 patient developed 59 hospital acquired infection.• Infection density- 36.2 infection per 1000 patient day• Commonest- invasive wound infection
U.T.I. study in JNMC Aligarh• Performed by M. Akram, M.Shahid, A U Khan in 2007.• 100 sample infected out of 920 tested urine sample.• Infection of E. Coli- 61% Klebsiella – 22%
Hospital acquired infection can be considered from 3 angles1) Source2) Route of spread3) recipients
WHO guideline for hand hygiene in health care• Washing hand with soap & water• Preferably use an alcohol based hand rub for routine hand antisepsis• When alcohol based hand rub is already used do not used antimicrobial soap concomitantly.
Perform hand hygiene• Before & after having direct contact with patients• Before handling an invasive device for patient care regardless of whether or not gloves are used• After contact with body fluid or excretion , mucus membrane, non intact skin, or wound dressing.• If moving from a contaminated body site to a clean body site during patient care.• After contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient.
4) disinfection• Sterilization of instrument• Disinfection of article used by patient• Patients urine, faeces, sputum should be properly disinfected
5) Dust control • Suppression of dust by wet dusting & vacuum cleaning
9) Administrative measures• There should be hospital control of infection committee
Hospital infection control committee• Medical superintendent- chairperson• Representative from major clinical departments.• Representative for nursing services.• CSSD in charge.• OT in charge.• Microbiologist.
An attempt should be made to achieve and maintain an averagecount of 10-15 bacteria/cubic foot of air in hospitalless than 5 bacteria/ cubic foot- minimal risk of infectionmore than 35 bacteria/ cubic foot of air- heightened risk
Guideline to evaluate the floor cleaning procedure Based on rodac plate count• 0-25 bacteria/cubic foot- good floor cleaning procedure• 26-50 bacteria/cubic foot- satisfactory• More than 50 bacteria/cubic foot- not satisfactory
Role of central sterile supply department (CSSD)• CSSD is an accepted feature of hospital planning.
Function of CSSD• Supply of sterile instrument & material for dressing & procedure carried out in wards & department.• Sterilization of instrument & linen for use in operation theatre
CSSD also look after• Disinfection & sterilization of medical equipment such as ventilators, baby incubators, oxygen tents etc.• Selection & distribution of single use (disposable) sterile supplies such as catheters, suction tubing & syringe.
References• Park’s textbook of Preventive & social medicine• Harrisons principle of internal medicine• Textbook of microbiology: Ananthnarayana• Bennett & Brachmans hospital acquired infection: William R. Jarvis• Hospital administration: Francis & De Souza• www.burnsjournal.com date 09-07-2012• www.ann-clinmicrob.com date 09-07-2012• www.jornalofhospitalinfection.com date 09-07- 2012• CSSD of UP RIMS&R Saifai, Etawah