Hospital Acquired Infections/Health care associated infections/Nosocomial infection . More useful for MBBS ,PG (MD/MS) Students to get a brief idea about HAI.

1. DR ARUNA RANI BEHERA
DEPARTMENT OF MICROBIOLOGY

2. ○Hospital acquired infections
○Sources of infection
○Routes of spread
○Hospital Infection Prevention and Control Guidelines
○Universal and standard precautions

3. ○HAI or nosocomial infections or healthcare associated
infections defined as infections acquired during hospital
care by a patient:
-Who is admitted for a reason other than that infection
-Infection is not present or incubating at admission.
-Symptoms should appear at least after 48 hours of admission
-Include infections acquired in the hospital but appearing after
discharge and occupational infections among staff of the
health care facility

4. Factors affecting HAI
 Immune status-
 patients at the extremes of age
 patients with diabetes
 receiving immunosuppressive drugs
 patients with cancer, in particular those undergoing
chemotherapy
 Hospital environment
 Hospital organisms
 Diagnostic or therapeutic interventions
 Transfusions

6. Other
patients
Visitors
Water /
food
Air
Surgical
procedu
res
Hospital
persons
Devices,
drains
and
catheter
Fomite
contami
nation
Pt’s
normal
flora

7. Microorganisms lmplicated in HAIs
 Staphylococcus aureus
 klebsiella pneumoniae
 Acinetobacter baunumnii
 Pseudomonas aeruginosa
 Enterobacter species
 Escherichia coli
 Nosocomially acquired Mycobacterium tuberculosis
 Legionella pneumophila
 Candida albicans

8. Major Hospital-acquired infection
 Catheter-associated urinary tract infection (CAUTI)-
33%
 Central line-associated blood stream infection
(CLABSI)-13%
 Ventilator-associated event (VAE)-15%
 Surgical site infection (SSI)-31%.
 ICNs under the supervision of the officer in-charge of HICC
conduct HAI surveillance.
 5-10% of patients develop HAI

9. CA-UTI
Device
criteria
Presence of a urinary catheter for > 2 days.
Clinical
criteria
Presence of any one symptom of UTI such as fever,
suprapubic tenderness, urgency, frequency or dysuria.
Culture
criteria
Isolation of significant count (≥ 105/mL) of a UTI
pathogen from urine.

10. CLABSI
Age Blood culture criteria Clinical criteria
Organism isolated No. of cultures
positives
LCBI-1 Any age LCBI pathogen1 1 Symptoms not
required
LCBI-2 >1 year LCBI commensal2 2 Any one
symptom3
LCBI-3 <1 year 2 Any one
symptom4
Device criteria= catheter present for > two calendar days
LCBI plus catheter criteria met = called as CLABSI
LCBI without catheter criteria met= called as non-CLABSI
• LCBI- laboratory confirmed blood stream infection
• 1LCBI pathogen- e.g. common hospital acquired pathogens
• 2LCBI commensal- e.g. Coagulase negative staphylococci 3LCBI-2 symptoms- fever,
chills, hypotension
• 4LCBI-3 symptoms- fever, hypothermia, bradycardia, apnea

11. VAE (Ventilator associated events)
Stage-1: VAC (ventilator associated condition)
Device criteria Presence of a mechanical ventilator at least for two calendar 2 days.
Oxygenation
criteria
 Baseline period during which the daily minimum FiO2 (fraction
of inspired oxygen) and PEEP (positive end-expiratory pressure)
values are stable or decreasing for 2 days followed by
 Period of worsening of oxygenation- increased FiO2 (by ≥ 20%)
or PEEP (≥ 3 cm water) for at least 2 days

12. VAE (Ventilator associated events)
Stage-2: IVAC (infection related ventilator associated complications)
Clinical
criteria
Any one out of four-
Fever or hypothermia
Leucocytosis or leukopenia
Antibiotic
criteria
New antimicrobial agent started and continued for ≥ 4 days
Stage-3: PVAP (Possible ventilator associated pneumonia)
Culture
criteria
Isolation of significant count of a pneumonia pathogen from
respiratory specimens such as tracheal aspirate,
bronchoalveolar lavage etc.

13. Surgical site infection (SSI)
Definition
Surgical site infections (SSI) are defined as infections that
develop at the surgical site within 30 days of surgery (within 90
days for breast, cardiac and joint surgeries).

14. Type of SSIs
SSIs are classified based on level where infection developed.
 Superficial SSI- develops at the level of superficial incisional site (skin and
subcutaneous level) within 30 days regardless of type of surgery.
 Deep SSI- develops at the level of deep incisional site (muscle and fascial level)
within 30 days for all surgeries except breast, cardiac and implant surgeries (90
days)
 Organ space SSI- develops at the level of organ space site within 30 days for all
surgeries except breast, cardiac and implant surgeries (90 days).

15. One among the following must be met:
Clinical
criteria
(i) presence of purulent pus from the corresponding level of surgical
site or
(ii) presence of local signs of infections (pain/tenderness, swelling,
erythema, heat etc).
Culture
criteria
Positive culture from the discharge collected at the corresponding level
of surgical site.
Other
evidence
(i)For superficial SSI- Surgeon’s diagnosis is taken as diagnostic criteria
(ii)For deep or organ space SSI- histopathological, imaging or gross
anatomical evidence of abscess should be present.

16. Formulae of HAI Infection
Rates
HAI infection rates Formulae
VAE Rate No. of VAE cases/ total no. of ventilator
days X 1000
CLABSI Rate No. of CLABSI cases/ total no. of central
line days X 1000
CA-UTI Rate No. of CA-UTI cases/ total no. of
catheter days X 1000
SSI Rate No. of SSI/ No. of surgeries done X 100

17. Prevention of device-associated
infections (DAIs)
 Bundle care approach
o Bundle care comprises of 3 to 5 evidence-based
elements with strong clinician agreement.
o Each of the component must be followed during the
insertion or maintenance of the device
o Compliance to the bundle care is calculated as all or-
none way, i.e. failure of compliance to any of the
component leads to non-compliance to the whole
bundle

18. Bundle care for Urinary catheter
Insertion bundle Maintenance bundle
1. Inserted only when appropriate
indication is present
1. Daily catheter care
2. Sterile items 2. Properly secured
3. Non-touch technique 3. Drainage bag must be above the floor and
below the bladder level.
4. Closed drainage system 4. Closed drainage system
5. Appropriate size catheter 5. HH and change of gloves between patients;
separate jug for each bag, alcohol swabs for
outlet – while emptying urine
6. Secured after placement
6. Daily assessment of readiness of removal

19. Bundle care for central line
Insertion bundle Maintenance bundle
1.Hand hygiene 1.Daily aseptic CL care during handling
 Hand hygiene
 Alcohol hub decontamination
2. Sterile PPE
3. Site of insertion-
Subclavian preferred, avoid femoral
2.Daily documentation of local sign of infection
4. Chlorhexidine skin preparation 3.Change of dressing with 2% Chlorhexidine
5. Skin must be completely dry after use
of antiseptics
4.Daily assessment of readiness of removal
6.Use semi permeable dressing
7.Hand wash after procedure
8.Document data and time of insertion

20. Maintenance bundle
• Adherence to hand hygiene
• Elevation of the head of the bed to 30-450
• Daily oral care with chlorhexidine 2% solution
• Need of PUD (peptic ulcer disease) prophylaxis to be assessed daily; if needed only
sucralfate should be used.
• DVT (deep vein thrombosis) prophylaxis should be provided if needed.
• Daily assessment of readiness to removal of MV

21. Prevention of SSI
Preoperative measures
1. Preoperative bathing
2. For MRSA nasal carriers: Decolonization with mupirocin
ointment
3.Hair removal: strongly discouraged, If needed should be
removed only with a clipper.
4. Pre-operative oral antibiotics - elective colorectal surgery.

22. Intra-operative measures
1.Surgical antimicrobial prophylaxis (SAP) must be provided for all except clean
surgeries.
 Administered within 60-120 minutes before incision
 Choice- depends upon local antibiotic policy. Cefazolin or cefuroxime are the usual
agent of choice.
 Frequency- SAP is usually given as single dose. Repeat dose may be required only
for: duration >4 hr, cardiac surgeries, drugs with lower half-lives, extensive blood
loss during surgery
2. Surgical hand disinfection
3. Surgical site preparation should be performed with alcohol-based chlorhexidine
antiseptic solution.
4. Perioperative maintenance of oxygenation, temperature, blood glucose level,
circulating volume and nutritional support during surgery and immediate 4-6hr
postoperative period.

23. Post -operative measures
1. Daily wound dressing
2. OT disinfection - with a high level disinfectant, in between cases and after the last
case (terminal disinfection).
3. Periodic monitoring the air quality of OT for various parameters such as no. of air
exchanges, temperature, humidity, pressure and microbial contamination.
4. SAP prolongation is not recommended.

24. Integral component of the patient safety program of the
health care facility, and is responsible for establishing and
maintaining infection prevention and control, its
monitoring, surveillance, reporting, research and
education.

25. 1. Chairperson: Head of the Institute (preferably)
2. Member Secretary: Senior Microbiologist
3. Members: Representation from Management /Administration
(Dean/Director of Hospital, Nursing Services, Medical Services,
Operations)
4. Relevant Medical Faculties
5. Support Services: (OT/CSSD, Housekeeping / Sanitation,
Engineering, Pharmacologist, Store Officer / Materials
Department)
6. Infection Control Nurse
7. Infection Control officer

26. 1. Hand hygiene
2. Personnel protective equipment
3. Safe handling and disposal of sharps
4. Follow needle stick injury protocol
5. Safe handling and disposal of wastes
6. Managing blood and body fluids
7. Disinfection of equipment
8. Environmental disinfection
9. Immunization
10.Isolation

29. Personal Protective equipment
Must be used whenever high risk patient is being handled
 Gloves
 Disposable plastic Apron
 Masks.
 Eye protection

30. BMW
 YELLOW-infectious nonplastic
 RED-Infectious plastic
 WHITE(TRANSLUCENT)-waste sharps
 BLUE-glasswares

31. Infection control
checklist
1. Have you washed your hands?
2. Do you need to use personal protective
equipment?
3. Are you preventing sharp injuries?
4. Are you disposing off waste safely?
5. Do you deal promptly with spillages?
6. Do you thoroughly decontaminate
equipment?
7.Are you maintaining a clean environment?
8.Do you know what to do in the event of an
accident?
9.Do you know your workplace's procedures?

32. GET INVOLVED
AND
HOSPITAL
ACQUIRED
INFECTIONS