A brief presentation about hospital acquired infection.

2. Welcome

3. The Silent Killer in Hospital
DR. Rana Shankor Roy
Lecturer
Department of Microbiology

5. What was her fault?

6. She was progressing in the neonatal intensive
care unit until she developed a bloodstream
infection related to her umbilical catheter.
Your baby was born prematurely.

7. The surgery goes well
but he later dies in a
nursing home of a
MRSA wound infection
that developed after
surgery.
Your father has open heart surgery.

10. Please Do no harm to your
patient
Some hospitals let a preventable
infection kill their patients

11. Hospital Acquired Infection

12. Hospital acquired infection (HAI)
Hospital acquired infection— also known
as Nosocomial infection/ Health Care-
Associated Infections.

13. Definition
An infection occurring in a patient in a
hospital or other health care facility in
whom the infection was not present or
incubating at the time of admission.
This also includes occupational infections
among staff of the facility

14. Simply it is -
An infection acquired in hospital by a
patient who was admitted for a reason
other than that infection.

15. Global Infection Problems
According to WHO,
On average, 8.7% of hospital patients
suffer from health care-associated
infections (HAI).
In South-East Asia Regions: 10%

16. Global Infection Problems (Cont..)
In developing countries: Risk of HAI: 2-
20 times higher
In India the nosocomial infection rate is
at over 25-30%.

17. What's about Bangladesh?
prevalence rate was 8.33%
53.33% were surgical site infections
50% were caused by Escherichia Coli
81.3% had visitors more than 3 per day

18. RISE IN HAI AS A RESULT Of-
Crowded hospital conditions
Increasing people with compromised
immune system
Increasing Bacterial resistance (MRSA,
resistant Gram negatives)

19. Crowded hospital conditions

20. Impact of HAI
Increase patients’ suffering
Add to functional disability and
emotional stress of the patient
May lead to permanent disability.
May lead to death.

21. Impact of HAI (Cont.…)
Prolong hospital stay.
Increase the costs to patients.
add to the imbalance between resource
allocation

22. Main Sources of Infection
Person to person via hands of health-care
providers, patients, and visitors
Personal clothing and equipment (e.g.
Stethoscope)

23. Main Sources of Infection (Cont..)
Environmental contamination
Airborne transmission
Hospital staff who are carriers

24. Sources of Infection

27. Nosocomial infection sites
Urinary tract infections (UTI) : Catheter
associated UTIs are the most frequent,
accounting for about 35% of all HAI.
Surgical site infections:
about 20% of all HAI

28. Nosocomial infection sites (Cont..)
Bloodstream infections associated with
the use of an intravascular device: about
15% of all HAI
Pneumonia associated
with ventilators:
about 15% of HAI.

29. Sites of the most common
nosocomial infections

30. AGENTS OF HA INFECTIONS
Virus
Bacteria
Fungus

31. Bacteria -
Most common nosocomial pathogens.
Escherichia coli
Staphylococcus aureus
Pseudomonas aeruginosa
Streptococcus pyogenes
Proteus, Klebsiella, Enterobacter

32. Do You Know?
Multidrug resistant
Staphylococcus
aureus (MRSA):
colonize hospitals &
cause Nosocomial
infections.
Thus, known as
‘Hospital
Staphylococci’

33. Virus
Hepatitis B and C viruses
Respiratory syncytial virus (RSV)
Rotavirus
Enteroviruses etc.

34. Parasites and fungi-
Giardia lamblia
Sarcoptes scabies
Candida albicans
Aspergillus spp.
Cryptococcus neoformans
Cryptosporidium

35. LETS KILL THE POSSIBILITY OF INFECTION

36. HAI is everybody’s business
Clinical
Doctors
Nurses
Microbiologists, etc.
Construction
Engineers
Architects, etc.
Facilities Management
Cleaning , Catering
Waste Management
Maintenance
Estate engineering
Strategic management
Healthcare managers
Policy makers, etc.
PREVENTION & CONTROL OF HAI

37. PREVENTION & CONTROL OF HAI By-
Reducing person-to-person transmission
Preventing transmission from the environment
Protecting patients with appropriate use of
prophylactic antimicrobials, nutrition, and
vaccinations
Patient isolation- eg. in Pertussis/TB etc.

38. Limiting the risk of endogenous infections by
minimizing invasive procedures, and promoting
optimal antimicrobial use.
Surveillance of infections, identifying and
controlling outbreaks
Prevention of infection in staff members
Enhancing staff patient care practices, and
continuing staff education.

39. Reducing person-to-person transmission
Hand decontamination
Personal hygiene-
-Nails must be clean and kept short.
-Hair must be worn short or pinned up.

40. Gloves
-Hands must be washed when gloves are
removed or changed.
Clothing
-If possible, a clean outfit should be
worn each day.
-An outfit must be changed after
exposure to blood or if it becomes
wet through excessive sweating
or other fluid exposure.

41. Masks
-Paper masks with synthetic material for
filtration are an effective barrier against
microorganisms.
Safe injection practices

42. Hand decontamination
Transmission of hospital infections can be
minimized with appropriate hand hygiene.
Compliance with handwashing, however, is
frequently suboptimal.
Frequent hand washing esp. between patients

44. Do you Know?
You can get 100s to 1000s of bacteria on your
hands by doing simple tasks like: Assisting
patient up in bed / Touching patient’s gown or
bed sheets
Hand Washing is Important
Because…80% of disease is
spread by your hands.

46. Your 5 moments for hand hygiene
at the point of care
46

47. For handwashing
Running water
Products: soap or antiseptic depending
on the procedure
drying without contamination
(disposable towels if possible).

50. Preventing transmission from the
environment
Cleaning of the hospital environment
Disinfection of patient equipment
Sterilization of instrument e.g.
nebulizer/oxygen mask/Use of single-use
disposable items

51. Cleaning hospital environment

52. Zones of hospital area with cleaning
technique
Zone Area Cleaning Technique
A
Administration, library Normal domestic cleaning technique
B
General ward Detergent solution
C
Isolation wards Detergent/disinfectant solution.
Use separate cleaning equipment for each room.
D
OT, delivery rooms, ICU,
NICU, casualty dept.
Clean using a detergent/disinfectant solution.
Use separate cleaning equipment.

56. Role of hospital management
Establishing a multidisciplinary infection control
committee
Ensuring education and training of all staff
Periodically reviewing the status of nosocomial
infections
Reviewing, approving, and implementing policies
approved by the infection control committee

57. Role of physician in preventing HAI
Providing direct patient care using practices
which minimize infection
Following appropriate practice of hygiene
(e.g. handwashing, isolation)
Protecting their own patients from other
infected patients

58. Role of physician (Cont..)
Complying with the practices approved by the
Infection Control Committee
Obtaining appropriate microbiological specimens
when an infection is present or suspected
Notifying cases of hospital-acquired infection to the
team.

59. Role of the nursing staff
Maintaining hygiene, good nursing
practice on the ward
Maintaining aseptic techniques
Limiting patient exposure to infections
from others
Reporting promptly to the attending
physician any evidence of infection in
patients

60. Infection control committee
Integral component of the patient safety
program of the health care facility
Responsible for establishing and
maintaining infection prevention and
control, its monitoring, surveillance,
reporting, research and education.

61. Infection control committee structure
Chairperson: Head of the Institute (preferably)
Member Secretary: Senior Microbiologist
Members: Representation from
Management /Administration
(Director of Hospital, Nursing
Services, Medical Services,
Operations)

62. Relevant Medical Faculties
Support Services: (OT, Housekeeping /
Sanitation, Engineering, Pharmacologist, Store
Officer)
Infection Control Nurse
Infection Control officer
Infection control committee structure

63. HAI are the most frequent adverse event
in health-care delivery worldwide
HAI is an infection acquired in hospital by
a patient who was admitted for a reason
other than that infection.
Home Message

64. On average, 8.7% of hospital patients
suffer from HAI.
In developing countries, Risk of HAI is 2-
20 times higher
Home Message (Cont..)

65. UTI is the most frequent health care-
associated infection in high-income
countries
surgical site infection is the leading
infection in developing countries
Home Message (Cont..)

66. Newborns are at higher risk of acquiring
health care-associated infection in
developing countries
Many different bacteria, viruses, fungi
and parasites may cause nosocomial
infections
Home Message (Cont..)

67. Prevention of nosocomial infections is
the responsibility of all individuals and
services providing health care.
Hand Hygiene : single most effective
intervention to reduce the cross
transmission of HAI
Home Message (Cont..)

68. One more important thing!
Protect Yourself
Be sure you have been immunized against
Vaccine preventable
diseases