Hospital infections Emerging Trends


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Hospital infections Emerging Trends

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Hospital infections Emerging Trends

  1. 1. Dr.T.V.Rao MD Dr.T.V.Rao MD 1
  2. 2.  A Tribute to Ignaz Semmelweiss (1818-1865) Ignaz Semmelweiss (1818-1865)  Obstetrician, practised in Vienna  Studied puerperal (childbed) fever  Established that high maternal mortality was due to failure of doctors to wash hands after post- mortems  Reduced maternal mortality by 90%  Ignored and ridiculed by colleagues Dr.T.V.Rao MD 2
  3. 3.  Dr.T.V.Rao MD 3 Hospital Infection Hospital infection is also called Nosocomial infection. It is the single largest factor that adversely affects both the patient and the hospital
  4. 4.  What is Hospital Acquired Infections Any infection that is not present or incubating at the time the patient is admitted to the hospital Dr.T.V.Rao MD 4
  5. 5. 1. Advancing age of the patients, as they are more prone to infection. 2. Use of sophisticated and complicated equipment which is not easy to clean, disinfect or sterilize. 3. Increasing specialization bringing together patients susceptible to some type of infection. Dr.T.V.Rao MD 5 Why is infection such a problem even after 100 years since Lister and Pasteur ?
  6. 6.  4. Increased use and trial use of antibiotics resulting in drug resistance. 5. Higher rate of staff turnover makes it difficult to maintain uniform standards 6. Effective sterilization system as yet not fully understood by all concerned. Dr.T.V.Rao MD 6 Increasing trends
  7. 7.  7 Additional morbidity Prolonged hospitalization Long-term physical, developmental and neurological sequelae  Increased cost of hospitalization  Death Consequences of Hospital Acquired Infections Dr.T.V.Rao MD
  8. 8.  Dr.T.V.Rao MD 8 Why Everyone Concerned with Hospital Infections The Centers for Disease Control (CDC) estimates that 2 million U.S. patients a year acquire hospital- related infections.
  9. 9.  Infection control is the discipline concerned with preventing nosocomial or healthcare- associated infection. As such, it is a practical (rather than an academic) sub-discipline of epidemiology. It is an essential (though often under-recognized and under-supported) part of the infrastructure of health care. What is Infection Control Dr.T.V.Rao MD 9
  10. 10.  Infection control addresses factors related to the spread of infections within the health-care setting (whether patient-to-patient, from patients to staff and from staff to patients, or among-staff), including prevention (via hand hygiene/hand washing, cleaning/disinfection/sterilization, vaccination, surveillance), monitoring/investigation of demonstrated or suspected spread of infection within a particular health-care setting (surveillance and outbreak investigation), and management (interruption of outbreaks). Infection Control is Complex programme Dr.T.V.Rao MD 10
  11. 11.  Beginning of Hospital Infection Programme  Modern hospital infection control programs first began in the 1950s in England, where the primary focus of these programs was to prevent and control hospital-acquired staphylococcal outbreaks. In 1968, the American Hospital Association published "Infection Control in the Hospital," Dr.T.V.Rao MD 11
  12. 12.  First Data on Infection Control Efficacy  In 1985, the Study of the Efficacy of Nosocomial Infection Control (SENIC) project was published, validating the cost-benefit of infection control programs. Data collected in 1970 and 1976-1977 suggested that one-third of all nosocomial infections could be prevented Dr.T.V.Rao MD 12
  13. 13.  Joint Commission on Accreditation of Healthcare Organizations (JCAHO)  In 1969, the Joint Commission for Accreditation of Hospitals--later to become the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)--first required hospitals to have organized infection control committees and isolation facilities Dr.T.V.Rao MD 13
  14. 14.   Various substances such as disinfectants used to prevent cross infection are subject to risk assessment prior to use. Health and Safety guidance highlights the importance of the risk assessment process i.e. Identify the risk  Assess the risk  Note current measures which are being used to control or mitigate the risk  Inform/train staff  Monitor outcomes  Implement policies and procedures Risk assessment of Substances in use for ICP Dr.T.V.Rao MD 14
  15. 15.  Beginning of AIDS Pandemic Necceciates Stronger Infection Control Protocols The second and certainly most significant factor influencing infection control at the time was the advent of acquired immunodeficiency syndrome (AIDS). HIV has been a challenge for education, risk reduction and resource utilization. Dr.T.V.Rao MD 15
  16. 16.  Dr.T.V.Rao MD 16 Study of the Efficacy of Nosocomial Infection Control (SENIC) project  Study of the Efficacy of Nosocomial Infection Control (SENIC) project was published, validating the cost-benefit of infection control programs. Data collected in 1970 and 1976-1977 suggested that one-third of all nosocomial infections could be prevented if …..
  17. 17.  One infection control professional (ICP) for every 250 beds. An effective infection control physician. A program reporting infection rates back to the surgeon and those clinically involved with the infection. An organized hospital-wide surveillance system. Dr.T.V.Rao MD 17 What we need and what to do
  18. 18.   Decreasing reimbursement  Increasing emerging infections  Increasing resistant organisms  Increasing drug costs  Institute of Medicine Report--healthcare-associated infections  Nursing shortage  OSHA safety legislation  Multiple benchmark systems  FDA legislation on reuse of single-use devices Infection Control Challenges of Healthcare in 2000 Dr.T.V.Rao MD 18
  19. 19.  Infection control programs had to encompass not only hospitals but also the long-term care facility, home health/hospice, rehabilitation facilities, free-standing surgical centers, and physician office practices. A dramatic shift in patient care practices occurred as greater than 65% of surgery cases were operated on in an outpatient Infection control was influenced by the reform of the Healthcare System Dr.T.V.Rao MD 19
  20. 20.  Dr.T.V.Rao MD 20 Challenging Issues  Issues that will continue to impact infection control programs into the new millennium are a challenging combination of cost and clinical factors and increasing cost to treat infections, and financial impact of implementing new government regulations .
  21. 21.  Changing Demands on Infection Control programme  Today's ICP needs knowledge of epidemiology statistics, patient care practices, occupational health, sterilization, disinfection, and sanitation, infectious diseases, microbiology, education and management Dr.T.V.Rao MD 21
  22. 22.  Dr.T.V.Rao MD 22 Infection Control Committee and Antibiotic Policies are Back bone for reduction of Infections
  23. 23.   The major responsibilities for ICPs to oversee include surveillance, specific environmental monitoring, continuous quality improvement, consultation, committee involvement, outbreak and isolation management, regulatory compliance and education. To plan, coordinate, and succeed in fulfilling these responsibilities, many ICPs have to redefine their roles. More ICPs are becoming managers by creating multidisciplinary support teams to carry out many of the functions. Major Responsibilities of I C P Dr.T.V.Rao MD 23
  24. 24.  GUIDELINES AND RECOMMENDATIONS  Hand washing and Hospital Environmental Control * Immunization * Infectious Diseases Control * Intravascular Device- Related Infections and its control * Isolation Precautions Dr.T.V.Rao MD 24
  25. 25.   *Long-Term Care Facilities *Guidelines for Infection Control in Health Care Personnel * Surgical Site Infections Control * Urinary Tract and Respiratory Tract Infections Control * Ordering and Preparing Guidelines appropriately * Home care * Hospital Construction * Sterilization / DisinfectionDr.T.V.Rao MD 25 Scientific Disinfection Practices Saves Several Lives
  26. 26.  Surveillance  The key to ongoing monitoring is surveillance for nosocomial infections. Various techniques for surveillance have been described and evaluated including total house surveillance, targeted surveillance, Kardex, or laboratory-base Dr.T.V.Rao MD 26
  27. 27.  Computerized Surveillance  Surveillance traditionally involved significant manual data assessment Increasingly, integrated computerized software solutions are becoming available that assess incoming risk messages from microbiology and other online sources. Dr.T.V.Rao MD 27
  28. 28.  Outbreak Investigations  Unlike scheduled activities, occasional clusters of patients who are colonized or infected will trigger further investigation including a case-control study. New laboratory methods developed and refined within the last decade can now determine how related the strain is at the molecular level. Dr.T.V.Rao MD 28
  29. 29.  Infection Control Programme Integrated with Health Authorities  The institution usually makes the infection control program responsible for reporting communicable diseases required by state law. ICPs need to plan on interacting with local and state health departments regarding exposure that may need immediate community follow- up (e.g., tuberculosis, Cholera). ICPs should assist the health department in confirming cases that may have been seen in the hospital or clinic. Dr.T.V.Rao MD 29
  30. 30.   Every infection control program should develop a well-defined written plan outlining the organizational philosophy regarding infection prevention and control. The plan should take into account the goals, mission statement, and an assessment of the infection control program. It should include a statement of authority, and should review patient demographics including geographic locations of patients served by the healthcare system Formulating an Infection Control Plan Dr.T.V.Rao MD 30
  31. 31.  Staff Training in ICP  Education programs for employees and volunteers are one method to ensure competent infection control practices. It is a unique challenge since employees represent a wide range of expertise and educational background. The ICP must become knowledgeable in adult education principles and use educational tools and techniques that will motivate and sustain behavioral change. Dr.T.V.Rao MD 31
  32. 32.  Infection Control Programme and Documentation  Goals of the infection control program need to be incorporated into the mission statement of the facility. A mission statement should tell who you are, what you do, and should communicate a clear view of purpose and set a strategy for accomplishing the goal Dr.T.V.Rao MD 32
  33. 33.  Dr.T.V.Rao MD 33 Document Antibiograms With WHONET  WHONET is a free Windows-based database software developed for the management and analysis of microbiology laboratory data with a special focus on the analysis of antimicrobial susceptibility test results.
  34. 34.   CDC with the Hospital Infection Control Practices Advisory Committee (HICPAC) has produced or revised several major guidelines in the past two years including, Guidelines for Infection Control in Healthcare Personnel, and Guidelines for Management of Healthcare Worker Exposures to HIV and Recommendations for Post exposure Prophylaxis, Guidelines for Prevention of Surgical Site Infections. APIC has developed several guidelines covering topics including antisepsis and hand washing, disinfection and sterilization, endoscopy, and long-term care. CDC Guides the Medical profession ICP Dr.T.V.Rao MD 34
  35. 35.  Health Care Means In patient care and outpatient care  Significant trends in healthcare are occurring everyday including new medical procedures (i.e., gene therapy), new technology (multi- purpose intravenous catheters), and a shift from inpatient to outpatient care. Dr.T.V.Rao MD 35
  36. 36. Dr.T.V.Rao MD 36
  37. 37.  Dr.T.V.Rao MD 37 Light technology to combat Hospital Infections  A pioneering lighting system that can kill hospital superbugs – including MRSA and C.diff – has been developed by researchers at the University of Strathclyde in Glasgow, Scotland. The technology decontaminates the air and exposed surfaces by bathing them in a narrow spectrum of visible-light wavelengths, known as HINS-light.
  38. 38.   The technology decontaminates the air and exposed surfaces by bathing them in a narrow spectrum of visible-light wavelengths, known as HINS-light.  Clinical trials at Glasgow Royal Infirmary have shown that the HINS-light Environmental Decontamination System provides significantly greater reductions of bacterial pathogens in the hospital environment than can be achieved by cleaning and disinfection alone, providing a huge step forward in hospitals' ability to prevent the spread of infection. Dr.T.V.Rao MD 38 Light technology to combat hospital infections
  39. 39.  Dr.T.V.Rao MD 39 Light Technology to Combat Hospital Infections  HINS-light is a safe treatment that can be easily automated to provide continuous disinfection of wards and other areas of the clinical environment. The pervasive nature of light permits the treatment of air and all visible surfaces, regardless of accessibility, either through direct or reflected exposure to HINS- light within the treated environment
  40. 40.  Dr.T.V.Rao MD 40 Medical Dressing Uses Nanotechnology to Fight Infection  Scientists at the University of Bath and the burns team at the Southwest UK Pediatric Burns Centre at Frenchay Hospital in Bristol are working together with teams across Europe and Australia to create an advanced wound dressing.
  41. 41.  Dr.T.V.Rao MD 41 New Bandages Change Color If Infections Arise The dressing will work by releasing antibiotics from Nano capsules triggered by the presence of disease- causing pathogenic bacteria, which will target treatment before the infection takes hold.
  42. 42.  Dr.T.V.Rao MD 42 New Nanotechnology for Hospital Infection Control Receives FDA Approval  SilvaGard can be used to treat virtually any medical device and its use does not alter the device's original properties. Due to these and other unique attributes, SilvaGard is expected to have a significant impact on the battle against hospital- related infections.
  43. 43. Dr.T.V.Rao MD 43
  44. 44.  Dr.T.V.Rao MD 44 Long Sleeves x Short Sleeves  Results from a study by Denver Health and University of Colorado Health Services Center researchers showed there were no statistically significant differences found in bacterial or MRSA counts between physicians’ coats and newly laundered short-sleeved uniforms. The researchers’ findings sheds new light on British government agencies’ policies banning physicians’ white coats based on the belief that long sleeves carry more bacteria and pose a greater risk of bacterial transmission
  45. 45.  Dr.T.V.Rao MD 45 . Vision-based hand gesture recognition Technology  The technology relies on hand gestures as commands, which can control robotic nurses or tell computers to display pertinent patient health information, Juan Pablo Wachs, assistant professor of industrial engineering at Purdue University works and popularises.The vision- based hand gesture recognition technology could also be used for the coordination of emergency response activities during disasters.
  46. 46.  Dr.T.V.Rao MD 46 Involvement of Physicians More Important Physicians to be more involved and lead quality improvement efforts in their respective healthcare settings. Drs. Pronovost and Marsteller suggest that even though quality improvement efforts exist, there is not enough data supporting the notion that quality improvement efforts are actually enhancing patient outcomes. One of the reasons for this lack of progress, they say, is inadequate physician engagement and leadership in quality improvement work. Peter Pronovost, MD, PhD, and Jill Marsteller, PhD, MP
  47. 47.  Dr.T.V.Rao MD 47 Scientific Documentation Reduces Hospital Infections  Researchers evaluated the effect of an electronic medical record on the use of antimicrobial agents and infection rates of Clostridium difficile and MRSA. Results showed that implementation of an EMR significantly increased chart reviews and antimicrobial recommendations, leading to a decrease in antimicrobial use and MRSA as well as C. difficile infection rates.
  48. 48.  Impact of Hand Washing on Influenza  Health experts believe a flu epidemic was averted last year because of regular hand- washing, suggesting healthcare facilities should promote hand- washing among staff and patients to prevent the spread of disease. The American Society for Microbiology and the American Cleaning Institute released a study in Sept. 2010 reporting that 85 percent of people washed their hands in public restrooms in 2008, the highest levels observed since the research began in 1996. Dr.T.V.Rao MD 48
  49. 49.  Dr.T.V.Rao MD 49 Hand Hygiene Compliance  Researchers have implemented a hand hygiene program driven by a behavioral change approach to increase hand hygiene compliance. The hand hygiene program was packaged with several initiatives. It included access to alcohol sanitizer, education as well as ongoing audit and feedback. The program was also supplemented with behavior modification practices, such as immediate positive reinforcement as well as annually changing incentives. The researchers report the program has resulted in significant and sustained improvements in hand hygiene compliance.
  50. 50.  Dr.T.V.Rao MD 50 Which Skin Preparation Agent is Superior  Researchers conducted a review of surgical skin prep agents to conclude which agent was most cost-effective and superior in preventing surgical site infections. Based on information collected from two databases, researchers compared povidone- iodine, Chlorhexidine gluconate, parachoroxylenol and iodine povacrylex (0.7 percent available iodine) in 74 percent isopropyl alcohol (DuraPrep).
  51. 51.  Dr.T.V.Rao MD 51 Yet no Ideal Chemical Agent  Researchers concluded that each prep agent has specific advantages and disadvantages and no one skin prep agent is superior in all clinical situations. Factors to consider when choosing a skin prep agent include surgeon preference and environmental risks.
  52. 52.   Health care workers may be exposed to certain infections in the course of their work. Vaccines are available to provide some protection to workers in a healthcare setting. Depending on regulation, recommendation, the specific work function, or personal preference, healthcare workers or first responders may receive vaccinations for hepatitis B; influenza measles, mumps and rubella; Tetanus, diphtheria, pertussis; N. meningitides; and varicella.  The problem of resources for proving Vaccines in Developing countries continues to be real problem, need additional economic resources Health Care Workers are at Risk – Need for Vaccination Dr.T.V.Rao MD 52
  53. 53.  Become a Member of Alliance for the Prudent Use of Antibiotics (APUA)  An international organization dedicated to curbing antibiotic resistance  Chapters exist currently in several Asian countries: Australia, China, India, Nepal, Pakistan, Philippines, South Korea, Taiwan, Vietnam Dr.T.V.Rao MD 53
  54. 54.  Dr.T.V.Rao MD 54 Training Every One.. This is the single most important factor in the control of Hospital infection. A high sense of awareness and training goes a long way in controlling Hospital infection.
  55. 55.  Dr.T.V.Rao MD 55 Soap Water and Common sense are Best Antiseptics- William Osler
  56. 56.  Programme Created by Dr.T.V.Rao MD for Medical and Health Care Workers in the Developing World Email  Dr.T.V.Rao MD 56