Hospital acquired infections are infections that patients contract during a hospital stay. They arise more than 48 hours after admission and include infections like UTIs, respiratory infections, and surgical site infections. Common causes are bacteria like Staphylococcus aureus, Pseudomonas aeruginosa, and drug-resistant gram-negative rods. Infection control aims to prevent the spread of infections through practices like hand hygiene, environmental cleaning, and antibiotic stewardship. An antibiotic policy provides guidelines on appropriate antibiotic use to optimize treatment outcomes while reducing antibiotic resistance and costs. It includes education, prescribing strategies, and antibiotic audits.
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Hospital infection and control (dr mms 2017)
1. HOSPITAL ACQUIRED
INFECTION
(NOSOCOMIAL) INFECTION
Dr. Myint Myint SeinDr. Myint Myint Sein
Associate ProfessorAssociate Professor
Department of Public Health LaboratoryDepartment of Public Health Laboratory
ScienceScience
University of Public HealthUniversity of Public Health
2. Definition of HAI
• Infections that arise in hospital
• Infection neither present nor incubating at the
time of admission
• Infection that develops in patients after more
than 48 hours of hospitalization
• May appear after discharge from hospital
eg- post- op wound infection
• Contracted by healthcare staff
4. DEFINITION:
Any infection acquired by a patient in hospital
A nosocomial infection is an infection that is not
present or incubating when a patient is admitted to a
hospital
Bacterial nosocomial infections generally have an
onset of more than 48 to 72 hours after hospital
admission
5. History of nosocomial outbreaks
• First well-documented outbreak
– Puerperal (child-bed) fever in a hospital in
Vienna, 1847
– Ignác Semmelweis, Hungarian physician
gathered and analysed mortality data
– Autopsy room - Maternity wards
– Hand-washing intervention (chlorine
solution)
6. • Affects approx. 5- 10% of all in-patients
• Delays discharge
• HAI costs 2times >no infection
• direct cause deaths
7. About 9%of all hospitalized pts
As a result of their stay in hospital
Most common
UTI
RTI
Wound infections
9. TYPES OF NOSOCOMIAL INFECTIONS
Urinary tract infection
- most common type
-accounts for 40% of nosocomial infections
Surgical wound infection
-accounts for an additional 20%
Lower respiratory tract infections accounts for
15%
Nosocomial bacteraemia
- accounts for an additional 5%.
10. Urinary tract infection
Related to indwelling catheterization(80%) or
urologic instrumentation such as
cystoscopy(20%)
Catheter associated urinary tract infection
develops in up to 25% of catheterized
patients
Gram negative bacteria- common pathogens
12. Lower respiratory tract infection
Related to aspiration
Introduced by respiratory therapy such as
endotracheal suctioning or inhalation therapy
commonly caused by:
Staph aureus,
Pseudomonas spp
Gram negative bacilli
18. Factors increasing the risk of hospital-acquired
infections
- Patient risk factors
- Environmental risk factors
- Nature of the organism
19. Factors influencing the HAIFactors influencing the HAI
• Age – Neonates and
elderly have highest risk
due to inefficient
immunity.
• Infected patients-
Community acquired
infection may spread to
susceptible patients or
attendants
• Drug resistance-
Coliforms & Staph
aureus.
• Increased virulence
• Susceptible patients-
Pre-existing disease e.g.
Diabetes,
• Immuno-suppression,
prosthetic implants,
special care units
• Surgical procedures-
Bypassing natural mech
of body surface
Diagnostic /therapeutic
invasive procedures
20. Sources & Transmission of HAI
Endogenous(self-
infection)
- Patients own flora –
auto-infection( pts own
skin, GI, upper
respiratory flora)
Exogenous
Sources :
-Contact with other
patients/staff
-Environmental sources
like inanimate objects,
Mode of transmission
Contact
Hand & Clothing
Inanimate objects
Air borne route
Droplet from
respiratory tract
Aerosol by nebulizer,
humidifiers
Oral route- Food/ water
21. • Susceptible pts
- in neonatal units
- in burn units
- urological wards
- ICU pts
22. Major microbial causes
Gram positive cocci
- Staph aureus ,Staph epidermidis
-Group A & other streptococci
- Enterococci
- Anaerobic cocci
Gram negative bacilli
- Esch. coli & other coliforms
- Proteus-Morganella- Providencia
- Pseudomonas
-Salmonella
- Shigella
24. Notorious Pathogens
• Methicillin-resistant S. aureus (MRSA)
• Vancomycin-resistant enterococcus (VRE)
• Clostridium difficile
• Norovirus
• Multiply-drug resistant (MDR) gram
negative rods
• (e.g., P. aeruginosa, Acinetobacter)
They survive on environmental surfaces for
long periods of time and can be transiently carried on hands.
25. Methicillin resistantMethicillin resistant Staphylococcus aureusStaphylococcus aureus
((MRSA)MRSA)
Resistant to Flucoxacillin and usually others
May cause -
Wound infection
Bacteraemia
Skin/soft tissue infection
UTI
Pneumonia etc.
26. Colonisation common:
Nose, Axilla ,Perineum
- Wounds/Lesions
Spread By:
Hands
Fomites
Aerosols
Becoming more common in Community
Control:
Eradication of carriage
Barrier nursing
Screening of other patients Staff
27. VRE (vancomycin resistant enterococci)
Enterococcus faecalis and E. faecium
• Normal inhabitants of bowel
•UTI and wound infections in seriously ill patients
•Cross infection via contaminated equipment
•Patients with VRE are placed on contact isolation
32. The Inanimate Environment Can FacilitateThe Inanimate Environment Can Facilitate
TransmissionTransmission
Contaminated surfaces increase cross-transmission~
The Risk of Hand and Glove Contamination after Contact with a
VRE (+) Patient Environment..
X represents VRE culture positive
sitesz
36. Up to 85% of patients with C. difficile-associated disease
have antibiotic exposure in the 28 days before infection
Antibiotic exposure is
the single most
important risk factor
for the development
of Clostridium difficile
associated
Pseudomembranous
colitis
39. The CVC- is one of the most
commonly used catheters in
medicine
The CVC is typically
placed through a central
vein such as the IJ,
Subclavian or femoral
Central Venous Catheter (CVC)
These serve as
direct line for
microbial
bloodstream
invasion
42. Infection Control
The process by which health care facilities
develop and implement specific policies and
procedures to prevent the spread of infections
among health care staff and patients
43. HAI increasing in :
• Compromised patients
• Ward and inter-hospital transfers
• Antibiotic resistance
(MRSA, resistant Gram negative bacteria)
• Increasing workload
•staff pressures
•lack of facilities
44. High risks : Healthcare workers
They can get 100s to 1000s of bacteria on their
hands by doing simple tasks like:
– pulling patients up in bed
– taking a blood pressure or pulse
– touching a patient’s hand
– rolling patients over in bed
– touching the patient’s gown or bed sheets
– touching equipment like bedside rails,
overbed tables, IV pumps
45. Hospital Infection Control Committee
(HICOM)
Objective
– Investigation of all HAI
– Establish surveillance programme
– Provide guidance & leadership in prevention
& control of HAI
46. Hospital Infection Control Committee
Composition :Chairman – Hospital Suptdt
Membership:
Doctors
General physician
Infectious disease specialist
Surgeon
Clinical microbiologist
Members –All major specialty representatives,
Nursing matron, Infection control nurse
Engineering service representative,
47. Hospital Infection Control Committee
• Role & FunctionsRole & Functions
– Establish reporting system thru’
• Nursing unit report
• Individual patient report
• Bacteriology reports
• Autopsy report
– Periodical meetings to take decisions
– Lay down standards of asepsis, sterilization etc
– To prepare SOP Manual
– To take decision on all reports of HAI control officer
48. Surveillance
• Important means of monitoring HAI
Early detection of trends outbreaks
1. Laboratory Based
Microbiology Laboratory lists +ve organisms
‘Alert organisms’ reported
2. Ward Based
Ward staff monitor patients
53. Root Causes of Nosocomial Infections
Lack of training in basic IC
Lack of an IC infrastructure and poor IC practices
(procedures)
Inadequate facilities and techniques for hand
hygiene
Lack of isolation precautions and procedures
Inadequate sterilization and disinfection practices
and inadequate cleaning of hospital
54. Functions
Addressing food handling, laundry handling, cleaning
procedures, visitation policies
Obtaining and managing critical bacteriological data
and information
Developing and recommending policies and
procedures pertaining to infection control
Recognizing and investigating outbreaks of infections
in the hospital and community
Intervening directly to prevent infections
Educating and training health care workers, patients,
and nonmedical caregivers
55. Core Strategies to Reduce Nosocomial
Infections-Hand Hygiene
To ensure appropriate hand washing techniques—
Provide sinks, clean water, and soap at
convenient locations
alcohol-based products
Use gloves when necessary
Hand hygiene is the simplest, most effective
measure for preventing hospital-acquired
infections.
57. Ensuring a Clean Environment
Establish policies and procedures to prevent
food and water contamination
Establish a regular schedule of hospital
cleaning with appropriate disinfectants in, for
example, wards, operating theaters, laundry
Dispose of medical waste safely
58. Cleaning, Disinfection, and Sterilization of
Instruments and Supplies
Sterile Invasive Procedures and Intravenous
Medications-Intravascular devices ,Urinary catheter
Mechanical ventilation ,respiratory equipment
Ensure proper handling of inhalation medications
and supplies
Use antibiotic prophylaxis only when indicated
and according to established protocols.
59. Antimicrobial Use and Monitoring
Therapeutic guidelines
Prophylactic guidelines
Guidelines for surgical prophylaxis
62. ANTIBIOTIC POLICY
Antibiotic policy deals with recommendations for
specific antibiotic treatments and is usually derived from
a consensus view reached by detailed discussion among
a group experts in the field.
63. ANTIBIOTIC POLICY
• The aim of implementing this policy is to ensure that
antibiotics are used appropriately.
• This should result in more effective treatment of
infections so that patient outcomes are optimized.
• In addition, appropriate antibiotic use should minimise
the risk of healthcare-associated infections occurring and
• It produces benefits for patients and staff and for service
delivery and clinical outcomes.
64. ANTIBIOTIC POLICY
• Required in all hospitals
• Promote the practice of good medicine.
• Ensure the used of appropriate antibiotic for a specific
disease at optimal doses for correct duration
• Helps to limit the unnecessary use so that will avoid
exposure to side effects of the drug as well as decrease
emergence of resistance amongst the bacterial population.
• Reduce hospital cost.
• Improve education of junior doctors by providing
guidelines.
66. COMPONENTS OF
ANTIBIOTIC POLICY
1. Educational
Most important component
- continuously informing the doctors regarding the use
of antibiotics, any new agents
- resistance pattern, etc
- lectures, clinical meeting, newsletters
67. COMPONENTS OF
ANTIBIOTIC POLICY
2. Prescribing strategies
- designed to limit inappropriate use of antibiotics
- restrict drug list
- The need of authorization by physician
- AST results
- stop
68. COMPONENTS OF
ANTIBIOTIC POLICY
3. Antibiotic audit
To improve antibiotic prescribing
- improve quality of health care
- improve cost-effectiveness
- reduce or control levels of antibiotic resistance
Integral part of an antibiotic policy
- Regularly done
- Poor compliance – find out why
- Review the policy if necessary.
69. COMPONENTS OF
ANTIBIOTIC POLICY
Antibiotic audit (cont’)
1. Universal audit of all antibiotic prescriptions
2. Targetted Audit
- of specific situations
- of specific antibiotics
- for specific infections
- in selected units/areas
- for surgical prophylaxis
Depends on the needs and resources of the institution
- necessity for antibiotic usage
- correct choice, dose, duration, route
- cost-effectiveness
- outcome of treatment
70. COMPONENTS OF
ANTIBIOTIC POLICY
3. Antibiotic audit
To improve antibiotic prescribing
- improve quality of health care
- improve cost-effectiveness
- reduce or control levels of antibiotic resistance
Integral part of an antibiotic policy
- Regularly done
- Poor compliance – find out why
- Review the policy if necessary.
71. COMPONENTS OF
ANTIBIOTIC POLICY
Antibiotic audit (cont’)
1. Universal audit of all antibiotic prescriptions
2. Targetted Audit
- of specific situations
- of specific antibiotics
- for specific infections
- in selected units/areas
- for surgical prophylaxis
Depends on the needs and resources of the institution
- necessity for antibiotic usage
- correct choice, dose, duration, route
- cost-effectiveness
- outcome of treatment
Editor's Notes
Discuss Shanghai Children’s Hospital and HP.
Discuss Greek solid organ transplant delegation.
Discuss CIPTO BMT.
Recipe: 2 ml glycerin, propylene glycol, or sorbitol mixed with 100 ml of 60–90% alcohol.
Note: Hand and wrist jewellery including plain weddings bands should not be worn, as these are likely to increase the presence of gram negative bacilli
Nails should be short and clean and artificial nails should be discouraged as they contribute to increased bacterial counts.
Wet hands thoroughly with warm running water.
Keep hands lower than elbows and apply soap.
Use friction to clean between fingers, palms, backs of hands and wrists.
4. Rinse hands under running water until all soap is gone.
DO NOT TOUCH TAPS WITH CLEAN HANDS – IF ELBOW OR FOOT CONTROLS ARE NOT AVAILABLE, USE PAPER TOWEL TO TURN TAPS OFF.
5. Pat hands dry with a clean, single use towel.
A neutral soap should be used for routine handwashing.
If liquid soap is dispensed from reusable containers, these must be cleaned when empty and dried before refilling with fresh soap – refilling soap containers is a potential source of infection. Where possible single use soap containers or bladders should be used.
HANDWASH SOLUTIONS SHOULD NEVER BE TOPPED UP
Scrub brushes should not be used for routine handwashing because they can cause abrasion of the skin, and may be a source of infection.
Add Notes Here:
Waste disposal is a hot item. Open this topic for discussion for the group. What are people doing with waste, needles, syringes, contaminated items (i.e., blood, lab specimens)?
Three types of disinfectants:
1. Steam sterilization (for hospital equipment and supplies)
2. Heat sterilization (for glassware and metal)
3. Chemical sterilization (i.e., glutaraldehyde immersion for 10 or more hours) for heat sensitive supplies.
