Dr.Ashna Ajimsha PG Resident Department of Microbiology SGMC & RF Venjaramoodu Kerala

1. Hospital acquired infections
Dr. Ashna Ajimsha

2. Almost
always
MDR !
HAI
pathoge
ns

3. Definition
Hospital acquired infections are those which manifest in the
patient AT LEAST 48 HRS AFTER ADMISSION IN THE HOSPITAL,
which was neither present or incubating at the time of
admission.
• OLDER TERM – NOSOCOMIAL INFECTION.

4. An infection is a HAI if :
The patient was admitted for a reason other than this infection
Symptoms should appear 48 hours after admission
Infection was not present at the time of admission
Infections which manifest after discharge is also accounted under HAI
Occupational infections among staff of the hospital care facility

5. Factors affecting HAI
Immune status of the patient
Hospital environment
Hospital organisms (MDR)
Diagnostic/ therapeutic interventions
Transfusion of blood,blood products & IVF
Poor hospital administration

6. Sources of infection
Sources of infection
Endogenous
Exogenous
-Environmental souces (inanimate
objects)
-Health care workers (MDR carriers)
-Other patients

7. • Enterococcus faecium
• Staphylococcus aureus
• Klebsiella pneumoniae
• Acinetobacter baumannii
• Pseudomonas aeruginosa
• Enterobacter species
Major HAI pathogens : ESCAPE =
ESKAPE pathogens.

8. Others-
E. coli
Candida albicans
Nosocomial Mycobacterium tb
Legionella
Clostridium difficile diarrhoea
Blood borne infections- HIV,HBV,HCV

9. Modes of transmission
Contact transmission
•Direct contact – skin to skin : MC mode
•Indirect contact from contaminated inanimate objects & parenteral
transmission through sharps
Inhalational mode
•Droplet transmission - > 5microns size – short distance.
RSV,Meningits,diphtheria
•Airborne transmission - < 5 microns – suspended in air for longer duration –
more contagious. Eg : Legionella, M tB, measles, VZV.

10. Vector- borne transmission-rare
Common vehicle transmission-
food,water,devices,equipment

11. Major HAI- types
CAUTI-33%
CLABSI-
13%
VAP-15%
SSI-
31%

12. CAUTI-Catheter assoicated Urinary
tract infections
• Risk factors
• (1)advanced age
• (2) female gender
• (3) severe underlying disease
• (4) placement of a urinary cathete
• Organisms: Gram-negative rods -majority of hospital
acquired UTI’s
• -E. coli is number 1
• -S.aureus & Enterococci cause the remainder of the
infections

13. CLABSI-
Central line
associated
BSI
• Risk factors
Patient related-
o Age(<1 yr,>60yrs)
o Malnutrition
o low immunity
o Severe underlying disese
o loss of skin integrity(burn/bedsore)
o prolonged ICU stay
Device related- presence of central line
HCW related-poor infection control practices-
hand hygeine

14. Organisms
Cons
Staphylo
coccus
aureus
Gram
negative
rods
Candida

15. VAP-Ventilator associated pneumonia
• Risk factors
Patient related-
oprolonged ICU stay
oAspiration of oropharyngeal flora (supine position,semi
conscious stage)
Device related- endotracheal intubation
HCW related-poor infection control practices- hand hygiene
Organisms- Acinetobacter spp, Pseudomonas spp.

16. SSI-Surgical
site
infections
• -Surgical site infections (SSI) are defined
as infections that develop at the surgical
site within 30 days of the surgery
• -(50%) of SSIs develop after discharge of
the patients from the hospital
• Organisms
oFor clean wound: The skin flora of surgery
team/ environmental organisms -most
common -S. aureus.
oFor other types: The patients endogenous
flora (anaerobes and gram-negative rods)

17. Risk factors
Advanced age,obesity, malnutrition, diabetes
Infections at a remote site that spread through
blood stream
Pre-operative shaving of the site
Inappropriate timing of prophylactic
antimicrobial agent
The antimicrobial prophylaxis is given 1 hour
prior to the incision, usually along with the
induction of Anesthesia.

18. Prevention of HAIs
Prevention
Standard precautions
Specific/transmission-
based precautions

19. Standard
precautions
-Set of infection control practices used to
prevent transmission of diseases that can be
acquired by contact with- blood, body fluids,
non-intact skin (including rashes), and mucous
membranes
-These measures should be followed when
providing care to:
• All individuals, whether or they appear
infectious/ symptomatic or not
• All specimens (blood or body fluids) whether
they appear infectious or not
• All needles and sharps whether they appear
infectious or not.

20. Standard precautions-components
Standard
precautions
Hand hygiene
Personnel Protective
Equipment
Biomedical waste
management
Spillage cleaning
Disinfection
Respiratory hygiene
cough etiquette

21. Hand hygeine

22. Hand hygiene
methods
Hand rub –
chlorhexidine 2 –
4%/ 70-80%
ethyl alcohol
Duration-20-30
sec
Adv : no drying
required
Disadv : visible
soiling – not
sufficient.
Hand wash –
soap & water
40 – 60 sec
duration
required.

25. Personal Protective Equipment
•Protection of skin & mucosa from exposure to blood
/ body fluids & from health care worker’s hands to
the patients.
•Selection of PPE based on level of risk associated in
standard precautions& presence of high risk of
transmission etc.

28. Donning - wearing
gloves
Goggles/fa
e shield
Mask/resp
ator
Gown

29. Doffing- removing
Mask/resp
ator
Gown
Face
shield/gog
es
Gloves

30. Spill management
• < 10 mL –wipe spill immediately
with adsorbent material,discard
• Wipe with 10% sodium
hypochlorite,allow to dry
• > 10 mL-place disposable paper
towels to adsorb the spill—Pour
10% hypo over the towels, leave for
15 mins.
Respiratory hygiene
• Cover mouth & nose – while
coughing, sneezing with single use
tissue paper
• If tissue paper is NA- inner elbow
• Hand hygiene
• Keep away from mucosa ( eyes &
nose)
• Masks,separate queue for infective
pts
• Sputum collection-open space/
well ventilated room

31. Specific precautions
•Additional precautions taken over the
standard precautions when a disease of a
specific mode of transmission is suspected.
•Taken when standard precautions – not
sufficient.

32. Specific
precautions
Contact
precautions
Droplet
precautions
Airborne
precautions

34. Components
of contact
precautions
:
1. Isolation
-Individual room optional,
-cohorting desirable
1. Restriction of patient movement
to a room ; transfer with hand
hygiene & PPE.
2. PPE and hand hygeine for staff
3. Separate equipment for isolated
patient – BP cuff, nebulizer,
stethoscope etc
4. Environmental cleaning

36. Components
of droplet
precautions
:
1. Isolation
-Individual room essential
-negative pressure desirable
2.Restriction of movement- use mask
3.PPE- surgical masks for HCW

38. Components
of airborne
precautions
:
1. Isolation
-Individual room with adequate ventilation
& negative pressure essential
2.Restriction of movement-confined to room
3.PPE- surgical masks for HCW(N95)

39. HICC -Hospital infection control
committee

41. Functions of
HICC
• HAI Surveillance
• Develops a system for
identifying,reporting,analysing,investigating &
controlling HAI
• Antimicrobial stewardship program
• Policies and guidelines
• Education for HCW regarding HAI
• Staff health
• Outbreak management
• Communicates & cooperates with other depts.
• HICC meetings- not < 1/ month
• Reviews