Hospital infection

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Hospital infection

  1. 1. PREVENTION OF HOSPITAL AQUIRED INFECTION Presented By: Dr.P.P.Singh Ex.MEDICAL SUPRINTENDENT HRH &SDN HOSPITAL Ex.Director Project IPP-VIII Municipal Corporation of Delhi
  2. 2. Dr. P.P.SINGH
  3. 3. WHOLESTIC LIFECYCLE APPROACH TO WOMEN HEALTH 1. CSSM 3. CARE OF WOMEN FOR RTI/STI(AIDS) RCH 2. FAMILY PLANING 4. ADOLESCENT HEALTH Dr. P.P.SINGH
  4. 4. Definition • Infection acquired by the patients from hospital facilities i.e. - during hospitalisation - due to any therapeutic / diagnostic procedures Dr. P.P.SINGH
  5. 5. Sources of Hospital Infections • Cross Infection • Self or auto infections • Environmental Dr. P.P.SINGH
  6. 6. Prevalence of Hospital Acquired Infection • In early seventies Barrett Connor Estimated 3-13% • Estimate in USA Around 1.5 million cases of 5-20% and operative infections 4.7 to 21.8% with an average of 9.7% • WHO Estimated after study in 47 countries 3-21% with mean of 8.4% • India Authenticated data not available. Dr. P.P.SINGH References of few hospitals indicate around 10%
  7. 7. Aetiology • Like any other disease Process Hospital Infection has also got epidemiological triad i.e. the agent, host and environment • Entire spectrum of microbes i.e. bacteria, viruses, ricketsis, fungi and protozae etc. responsible for hospital infection • 20-25% of all Hospital Infections due to Gram +ve Organisms • Proteous, e-coli, salmonella, klebsiella, pseudomonas are on the rise cont. Dr. P.P.SINGH
  8. 8. Risk Factors • Patient factors: • • • • • • Extreme age Malnutrition Immune deficiency Injuries Diseases like Diabetes, Nephritis, Severe burns Endogenous infection cont. Dr. P.P.SINGH
  9. 9. • Microbial factors: •High conc. Of agent •High level of virulence •Emergence of resistant strains •Presence of new organism • Environmental factors: •Level of contamination •Medical interventions Dr. P.P.SINGH
  10. 10. Pathogenic Organisms • Gram Positive • Virus – Staphylococcus – Streptococcus – B.subtalis – – – – • Gram Negative – – – – – – – – E.coli Pseudomonas Proteus Klebsiella Citrobacter Shigella Salmonella Serratia Hepatitis A,B,C… HIV/AIDS Dengue Japanese encephelitis • Rickettesial – Typhus – Scrub fever • Protozoal – Malaria – Amoebiasis • Mycobacterial Dr. P.P.SINGH – Tuberculosis
  11. 11. Modes of transmission • Contact spread – Contaminated inanimate objects • catheters • Cystoscopes • Bed pans etc. – Person to person & Droplet infection • Infective Hepatitis • Streptococcal Pharyngitis Cont. Dr. P.P.SINGH
  12. 12. • Common Vehicle Spread – Transmission through food • Salmonella – through blood and blood products & Injections and intravenous fluids • • • • Hepatitis B & C HIV / AIDS Gram -ve Septicemia Salmonellosis Cont. Dr. P.P.SINGH
  13. 13. • Airborne spread – Vaccum cleaners & Dust Particles • Staphalococcal infection • Tuberculosis Dr. P.P.SINGH
  14. 14. • Vector Borne Spread – Body parts of vectors like • • • • • Mosquitoes Flies Flea Bugs Cockroaches Transmit Infections like » » » » Gastroenteritis Yersina pestis Malaria Dengue Dr. P.P.SINGH
  15. 15. Types of Hospital Acquired Infection • • • • • • • • • Urinary tract infections Lower respiratory tract infections Surgical wound infections Anaerobic bacteriological infections Gastroenteritis Transplant associated infections Intravenous cannula related infections Intracardiac & various prosthesis infections Perpureal infections Dr. P.P.SINGH
  16. 16. High Risk Procedures for HAI • • • • • • • Injections Surgical Procedures Dressing of wounds Management of deliveries Investigative procedures Laboratory investigations Dialysis Dr. P.P.SINGH
  17. 17. High Risk Areas for HAI • • • • • • • • Haemodialysis Unit Intensive Care Unit Nursery Unit Pharmacy Dietetics services Laundry Operation Theatre O.P.D. Dr. P.P.SINGH
  18. 18. Management of HAI • HAI Control Committee (meeting once a month) – Chairman Medical Superintendence – Member Secretary - Infection Control Officer (Microbiologist) – Members Head of all clinical units Chief of blood bank Microbiologist Medical record officer Chief of nursing services Infection control sister – Invited Members - Chiefs of all supportive services Dr. P.P.SINGH Cont. -
  19. 19. • • • • • • • • Surveillance of HAI Sterilisation and high level disinfection Proper discarding and disposal of hospital waste Universal blood and body fluid precautions by health care workers Dietetics services Laundry Antibiotic policy In-service training Dr. P.P.SINGH
  20. 20. Universal Precautions • • • • • • • • Wash hands before and after patient contact Wear gloves for contact with blood & body fluids Wear masks to protect against aerosols & splashes Wear gowns to protect against splashes Handle and dispose sharps safely Disinfect and sterilise critical items safe disposal of waste Hepatitis B vaccination Dr. P.P.SINGH
  21. 21. Safe Handling & Disposal of Sharps • Always dispose of your own sharps • Never pass sharps directly from one person to other • The risk of injury in high risk areas should be minimised by ensuring best possible visibility for operator • Protect fingers from injuries by using forceps while suturing • Locate sharps disposable container close to the point of use Dr. P.P.SINGH
  22. 22. Infection Control Indicator Checklist • Handle sharps safely to minimise injury – – – – Appropriate puncture proof sharps container Container less than three quarter full Sharps not protruding from container No recapping or one hand recapping of needle & syringe • Instrument decontaminated fully – Steriliser available and in good working order – Equipment thoroughly cleaned after use – Clean instruments stored in cupboards Dr. P.P.SINGH
  23. 23. • Hands washed appropriately to prevent cross infection – Soap and clean water available – Clean towels available – Staff wash & dry hands after contact with body fluid, removal of gloves and contact with patients • Protective barrier worn to prevent blood exposure Depending on the clinical area and risk of exposure use • • • • • Disposable gloves Heavy duty gloves Masks Aprons Protective eye wears Dr. P.P.SINGH
  24. 24. • Waste disposal safety – Evidence of deep burial or incineration regularly – No contaminated waste visible Dr. P.P.SINGH
  25. 25. Cost related to HAI • The outbreak infections are expansive. The cost increased can be summarised as – – – – – – Prolonged patient stay Increase consumption of disinfectants Increase use of protective clothing Increase in overhead expanses Cost associated with patient screening Need for expansive antibiotic therapy Dr. P.P.SINGH
  26. 26. HIV / AIDS PROBLEM IN DELHI. 35000 HIV +Ve. 780AIDS Cases. PROBABLE SOURCE •HETRO SEXUAL 75% •INJECTABLES 7.3% •RECIPIENT OF BLOOD •OTHER 7.5% 11% Dr. P.P.SINGH
  27. 27. AWERNESS (Education) A ACQUIRED INFORMATION I IMMUNO DRUGS(PRE) (Disinfectants) D DEFFICENCY SAFE SEX S SYNDROME Dr. P.P.SINGH ADULT HOOD INJECTABLES DRUGS SEX
  28. 28. RNA Virus Reverse transcription HIV1 &HIV2 Dr. P.P.SINGH
  29. 29. Common cold 5 – 15 years Anti bodies Death 6-8 wks Dr. P.P.SINGH
  30. 30. RISKS. Needle stick/prick injury--- 0.25 to 0.3% for HIV, 9 to 30% for HBV, 3-10% for HCV 0.3% risk through muco -cutanious exposure  0.6% IN NON SURGICAL.  4% IN SURGICAL, HIGER IN GYNAECOLOGIST  5 / 1000 IN OTHERS  40% WHILE SUTURING.  60% RECAPPING. Dr. P.P.SINGH
  31. 31. ANTISEPTICS HIV1&2 Hp B H2O2 0.3 3% ALCOHOL 50% 95% FORMALINE 0.5% 1% LYSOL 2% 3% BLEACH 1% 5% GLUTERALDEHYDE 2% 2% ULTRA VIOLET LIGHT- HIGHER DOSE LAMINAR FLOW, OT, LAB. DRYCLEANNING MAY NOT INACTIVATE Dr. P.P.SINGH
  32. 32. MISCONCEPTIONS  MOSQUITO BITE ANY INSECT BITE CASUAL CONTACT WITH AIDS pt. WITH IN HOUSE HOLD SHARING FOOD, WATER, CLOTHS OR TOILETS PROFESSIONAL CONTACT. Dr. P.P.SINGH
  33. 33. METHODS OF PREVENTION AMONGST HEALTH PERSONNEL 1. KNOWLEDGE, ATTITUDE,PRACTICE.    1. 2. 3. 4. 5. 6. Barrier precautions, Aseptic precautions Management of parenteral &MM exposure to blood/blood products, tissue organs. HAND WASHING WITH SOAP 10 -15 SECONDS WEAR GLOVES – BOTH HANDS, WASHING HAND AFTER REMOVING GLOVES. WEAR EYE GLASSES, FACE SHIELD ,APRON /GOWANS DECONTAMINATION / DISINFECTING – INSTRUMENTS,GLOVES,LINEN ALL THINGS WITH BLEACHING POWDER -15 gms /liter. - SURFACE – 10% BLEACH BIO MEDICAL WASTE ( BMW). P.E.P. Dr. P.P.SINGH
  34. 34. • SALIVA as source. - Mouth piece. - Resuscitation Bags -Ventilation devices - Suction machines -Mouth to Mouth Breathing • HOSPITAL DISINFECTANT- Chlorine – 1-1.5% Sod. Hypochlorite 1 gm/L Calcium hypochlorite 1.4 gm/L Bleach at least 10 min. Dr. P.P.SINGH
  35. 35. HANDLING SPECIMENS USE GLOVES SCREW CAPPED LEAK PRFOOF CONTAINERS CARE TAKEN WHILE TRANSPORT OF SAMPLES. SERA CAN BE KEPT - - HEAT 56 0 C FOR 30 MIN. NO MOUTH PIPETTINGS ANY SPILLAGE OF BLOOD & OTHER BODY FLUIEDS ON TABLE TOP OR ANY SURFACE – CLEAN WITH SOD. HYPOCHLORITE. ALL OPEN WOUNDS ON HAND & ARMS SHUOLD BE COVERED Dr. P.P.SINGH
  36. 36. ASEPTIC PRECAUTIONS (IN RELATION TO INJECTION / OTHER SKIN PIERCING PROCEDURES)  REDUCE UNECESSARY USE. SINGLE USE DISPOABLES REUASBLE SHOULD BE DIS INFECTED ,WASHED , & STERILISE PUNCTURE PROOF CONTAINERS P E P – ANY NEEDLE STICK , INJURY , CUTS OR MUCUS MEMBRAIN EXPOSURE. - WASH PROPERLY - BLEEDING IS ENCOURAGED Dr. P.P.SINGH
  37. 37. NON INVASIVE PROCEDURES  VAGINAL & RECTAL EXAMINATION. INTRA OCCULAR PRESSURE CONTACT LENSES TRIAL. TRACHIAL & LARYNGIAL EX. THROAT & NASAL EX. X RAY & CT SAN ETC, - THERE IS CHANCES OF BREAK OF MM. - BODY FLUIDS / SECRETION MAY ACT AS SOURCE OF INFECTION. *** EFFECTIVE USE OF STERILISATION & DISINFECTANTS Dr. P.P.SINGH
  38. 38. Conclusion • Prevention of Hospital Infection will cut the wasteful expenditure. Savings could be re-deployed for betterment of hospital • Incidence of Hospital Acquired Infection can be reduced to great extent by – – – – Work culture & attitude of health care providers Religious observation of universal precautions Application of antiseptic technique Proper Disposal of hospital waste Dr. P.P.SINGH

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