This document provides information on preventing hospital acquired infections. It discusses key topics like universal precautions, hand hygiene, use of personal protective equipment, and disinfection of medical equipment to prevent the spread of infections. The document emphasizes the importance of knowledge, skills, and proper techniques in infection control and outlines best practices for preventing common infections like those related to urinary catheters, central lines, and ventilators.

1. Continuing Nursing
Education(CNE).BD

2. Hospital Aquired Infection
(HAI)
Md. Ahasan Habib RN

3. Learning Objectives
1. Recognize patient safety as an important
nursing responsibility in global health
care systems.
2. Apply required knowledge in preventing
and/or minimizing infection.
3. Perform appropriate behaviors required
to prevent health care associated
infections.
4. Demonstrate required competence to
provide patients with safe care.

4. Introduction to Patient Safety:
Definition
 Patient safety is a discipline in the health
care sector that applies safety science
methods toward the goal of achieving a
trustworthy system of health care delivery.
Patient safety is also an attribute of health
care systems; it minimizes the incidence
and impact of, and maximizes recovery
from, adverse events (Emanuel et al., 2008) .

5. Introduction to Patient Safety:
Goal
 Prevent and/or minimize the adverse
events and eliminate preventable harm in
health care.
 All health care professionals including
nurses are responsible for ensuring patient
safety

6. Hospital Aquired Infection (HAI)
According to WHO:
 HAI is also called “nosocomial”.
 HAI is defined as:
an infection acquired in hospital by a patient
who was admitted for a reason other than that
infection.
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.

7. Impacts of Hospital Aquired
Infection (HAI)
HAI can:
 Increase patients’ suffering.
 Lead to permanent disability.
 Lead to death.
 Prolong hospital stay.
 Increase need for a higher level of care.
 Increase the costs to patients and
hospitals.

8. Preventing infections
Requires health care providers who have:
Knowledge of common infections and their
vectors
An attitude of cooperation and commitment
Skills necessary to provide safe care

9. Required Knowledge
 Knowledge of the extent of the problem;
 Knowledge of the main causes, modes of
transmission, and types of infections.

10. Required Attitudes
Being an effective team player.
Commitment to preventing HAIs

11. Required Skills
 Apply universal precautions*
 Use personal protection methods
 Know what to do if exposed
 Encourage others to use universal precautions
 Report breaks in technique that increase patient
risks
 Observe patients for signs and symptoms of
infection

12. One more important thing!
Protect Yourself
Be sure you have been immunized against
Hepatitis B since it is very easy to transmit!

13. Main Sources of Infection
 Person to person via hands of health-care
providers, patients, and visitors
 Personal clothing and equipment (e.g.
Stethoscopes, flashlights etc.)
 Environmental contamination
 Airborne transmission
 Hospital staff who are carriers
 Rare common-source outbreaks

14. Main Routes for infections
 Urinary tract infections (UTI)
Catheter-associated UTIs are the most frequent,
accounting for about 35% of all HAI.
 Surgical Site Infections (SSI): about 20% of
all HAI
 Bloodstream Infections (BSI) associated with
the use of an intravascular device: about
15% of all HAI
 Ventilator Associated Pneumonia (VAP):
about15% of HAI

15. PREVENTION OF CR-UTI
 The UTI following catherization are the most
common HAIs accounting for approximately
30-40% of all NCIs.
 There for it is important that catheterization
should be avoided if possible, and only be used
when there is clear medical indication
 Catheter should be removed as early as
possible preferably with in 10 days
 Indications for urinary catheterization-
 Closely monitor urinary output (haemodynamic
monitoring), bladder outlet obstruction, lack of
bladder control, signs that kidney’s are not
working well, the patient is severely ill etc

16. Considerations prior to catheterization
1.Urethral catheterization should be considered as a
minor surgical procedure
2.UC must be inserted using aseptic technique and sterile
equipments
3.Before the procedure, efficient and effective cleaning
should be undertaken
4.Aseptic technique should be maintained thru out the
procedure
5.Only closed urinary drainage system should be used
6.Prior to insertion procedure must be explained to the
patient

17. Catheter selection
 Choice of catheter material will depend on the clinical
experience and anticipated duration of catheterization
 Latex catheters are the least expensive but Silicone
catheters are comfortable and better choice for long
term use.
 Catheter size—Larger diameter block the urethral
gland and put pressure on the urethral mucosa and it
cause ischemic necrosis especially in males
 In general smaller diameter with 10 ml balloon allows
free flow of urine.
 Smallest catheter cause leakage , and urological
patients may need large diameter catheter but it must
be used by the advise of Urologist

18. Maintenance of catheter
 After insertion ,regular inspection of the
catheter and drainage system must be
attended and documented
 Meatal care—cleansing should be
performed at intervals appropriate for
keeping meatus free from contamination.
Cleansing with antiseptic solutions are
necessary to maintain hygiene
 If faecal contamination occurs perineum
must be cleaned and catheter should be
changed with out delay

19. Equipments required for
catheterization
 1.Sterile tray containing sponge holding
forceps, galipot, gauze, and cut sheet
 2 . Sterile gloves, Betadine solution,
distilled water, 10 cc syringe.2, lignocaine
jell 2%
 3.Sterile catheter as per requirement
 4.Sterile Drainage bag,
 5.Micropre

20. Procedure -catherization
 1.All equipments used must be sterile
 2.Hands must be washed thoroughly with an antiseptic
preparation
 3.Sterile gloves must be worn and no-touch aseptic
technique must be used
 4 .Peri urethral area must be cleaned thoroughly
 5.Use cut sheet to make the field sterile
 6.Single use sachet of sterile water soluble lubricant 1-
2% Lignocaine gel should be used on a catheter prior to
insertion to reduce pain, friction and trauma

21.  Gently insert the catheter and advance it by holding the
inner sterile surfaces
 Inflate the balloon by instilling the manufacture’s
recommended amount of sterile water
 Connect catheter to a sterile closed drainage system
 Attach the drainage bag with bed frame below the level
of the bed. The bag and tubing's must all the time below
the level of the bladder
 Secure catheter to patient’s thigh or abdomen to prevent
movement and urethral meatal ulceration
 Hands should be washed after gloves are removed
 Document the procedure (date & time ,and procedure
done by whom )
Procedure –catherization cont…

22. Specimen collection
 Obtain a urine sample from a sampling
port.
 Do not disconnect the drainage bag to
obtain sample. Sampling port must be
disinfected by wiping with hexisol then
sample may be aspirated using sterile
small bore needle and syringe and
transferred in to a sterile container.

23. Removal of catheter
 Optimal time limit for replacing catheter
depends on individual circumstances
 Use of anti microbial agents—
Administration of antibiotic at the time of
insertion may provide early benefit to
prevent CR- UTI
 Staff training—Ensure that health care
personnel are trained and competent to
carry out urethral catheterization

24. IV lines are an integral part of patient care.
They provide a route for administering
fluids, blood products, nutrients, iv
medications, for obtaining blood
specimens, etc
Prevention of Central line Related –
Blood Stream Infection (BSI)
Indications of CVC

25. Selection of Insertion site
 Select the insertion site and technique with
lowest risk of complications.
 C/L should not be inserted in to an area of
inflammation or infection
 Peripheral IV lines –upper extremity site
in preference to lower extremity in adults
 CVC—subclavian rather than jugular or
femoral site unless contra indicated ( eg
Porta-A cath ) should be used for patients
who require long term use ( 30days )

26. Procedure of insertion CVC
 Collect all necessary equipments
 Wash hands and use antiseptic hand rub
 Sterile gown, gloves and mask should be
worn, use large sterile drape to cover the
area.
 Disinfect insertion site by chlorhexidine for
at least 1mt to prior insertion
 Insert CVC maintaining no touch
technique thru out procedure. position of
the CVP line must be checked by x’ray

27. Procedure cont’d
 Leave the site clean and dry after insertion
 Secure the line with tegaderm and
dressing
 Label the site date and time and document
in patients record
 Connect the iv administration set
 Dispose sharps
 Wash and dry hands
 IV injection ports should be disinfected
with alcohol swab before administering
injections

28. Catheter site dressing
 Sterile dressing should be used to cover the catheter
site either a gauze or transparent dressing should be
used
 Sterile gloves should be used when changing dressing of
CVC
 The catheter site dressing should be replaced when the
dressing become damp, loosened, soiled, or when
inspection of the site is necessary
 The dressing should be changed on a regular basis
depending on the individual circumstances

29. VENTILATOR ASSOCIATED PNEUMONIA
(VAP)—PREVENTION
 VAP-Is an important cause of morbidity
and mortality in ventilated pts
 The measures to prevent VAP classified
as
 Pharmacological and non
pharmacological

30. Non Pharmacological measures
for preventing VAP
 Monitoring endotracheal tube cuff pressure
 Optimum pressure high enough to avoid gas
escape and the leakage
 The cuff pressure should be persistently
maintained at 20-30cmH2O
 Subglotic secretions drainage is
reccomended in pts expected to require more
than 72 hrs of ventilation

31. Cont…
 Avoiding delay in extubation
 Remove ET from pts as soon as the
clinical situation allows, the duration of
intubations can be reduced by protocols to
improve the use of sedation and to
accelerate weaning
 Avoiding re- intubations. It can be reduced
by avoiding accidental removal of the ETT,
and planed extubations

32. Sterilization & Disinfection
 Respiratory devices such as nebulizers,
resuscitation bags, Respirometers, should be
disinfected or sterilized for use in different
patients to avoid cross contamination
 Barrier measures—colonization of the hands of
the health care worker increases the risk of NCI
by cross contamination with procedures such as
suctioning, manipulation of ventilatory circuits
and bronchoscopy
 It can be reduced by using adequate barrier
measures such as hand washing, use of gloves ,
mask and gowns.

33. Semi recumbent position 30-45
degree
 Some studies have found the
semirecumbent position to be associated
with lower level of VAP incidence than in
supine position
 The position of the upper body of the
patient should not be less than 10 degree
at any time including basic care or
transport.

34. Oral cleaning and decontamination
 Recommend the use of chlorhexidine rinse
and mechanical cleaning of the oral cavity.
 Stress ulcer prophylaxis
 Avoidance of sedation and paralytic
agents

35. SURGICAL SITE INFECTION
Criteria for defining SSIs

38. Risk and prevention
Wound
classification
Patient factors Environmental factor
Clean Diabetes Preoperative antiseptic
showering
Clean-
contaminated
Obesity Preoperative hair removal
Contaminated Nicotine use Patient skin preparation
Dirty Steroid use Preoperative hand/forearm
antisepsis
Malnutrition Antimicrobial prophylaxis
Hospital stay 
Nares colonization
with S. aureus
Transfusion

39. Four Ways to Prevent HAI
1. Maintain cleanliness of the hospital.
2. Personal attention to handwashing before
and after every contact with a patient or
object.
3. Use personal protective equipment
whenever indicated.
4. Use and dispose of sharps safely.

40. Prevention in Hospitals and
Clinics
 Studies show infections are minimized
when hospitals/clinics:
Are visibly clean;
Use increased levels of cleaning during
outbreaks;
Use hypochlorite and detergents during
outbreaks.

41. Prevention through Handwashing
 Handwashing: the single most important
intervention before and after patient
contact.
 Required knowledge and skills:
How to clean hands
Rationale for choice of clean hand practice
Techniques for hand hygiene
Protect hands from contaminants
Promote adherence to hand hygiene guidelines

42. Five moments for hand hygiene
 Before patient contact
 Before an aseptic task
 After body fluid exposure even if wearing
gloves!
 After patient contact
 After contact with patient surroundings

43. Your 5 moments for HAND HYGIENE

44. How to Clean Hands
 Remove all wrist and hand jewelry.
 Cover cuts and abrasions with waterproof
dressings.
 Keep fingernails short, clean, and free
from nail polish.

48. Personal Protective Equipment
 Gloves, aprons, gowns, eye protection,
and face masks
 Health care workers should wear a face
mask, eye protection and a gown if there
is the potential for blood or other bodily
fluids to splash.

49. Personal protective equipment 2
 Masks should be worn
if an airborne infection is suspected or
confirmed
 to protect an immune compromised patient.

50. Gloves
Gloves must be worn for:
 all invasive procedures
 contact with sterile sites
 contact with non-intact skin or mucous
membranes
 all activities assessed as having a risk of
exposure to blood, bodily fluids, secretions and
excretions, and handling sharps or contaminated
instruments.
Hands should be washed before and after
gloving

51. Safe Use and Disposal of
Sharps
 Keep handling to a minimum
 Do not recap needles; bend or break after
use
 Discard each needle into a sharps
container at the point of use
 Do not overload a bin if it is full
 Do not leave a sharp bin in the reach of
children

52. Required Performance
Nursing students need to:
 apply universal precautions
 be immunized against Hepatitis B
 use personal protection methods
 know what to do if exposed
 encourage others to use universal
precautions

53. Act to Minimize
Spread of Infection-1
Before contact with each and every
patient:
 clean hands before touching a patient
 clean hands before an aseptic task

54. Act to Minimize
Spread of Infection-2
After contact with each and every patient:
 clean hands after any risk of exposure
to body fluids
 clean hands after actual patient contact
 clean hands after contact with patient
surroundings

55. Encourage Others to Participate
in Infection Control
Students may routinely observe staff who:
apply inadequate technique in handwashing
fail to wash hands
routinely violate correct infection control
procedures

56. References
 World Health Organization. (2010). WHO Patient Safety Curriculum
Guide for Medical Schools.
 World Health Organization. (2010). Topic 1: What is patient safety?
 World Health Organization. (2010). Topic 9: Minimizing infection
through improved infection control.
 Emanuel, L., Berwick, D., Conway, J., Combes, J., Hatlie, M., Leape,
L., Reason, J., Schyve, P., Vincent, C., & Walton, M. (2008). What
exactly is patient safety? Advances in Patient Safety, Vol. 1:
Assessment. Retrieved from
http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=aps2v1&part=ad
vances-emanuel-berwick_110
 Burke, J. P. (2003). Infection control — A problem for patient safety.
The New England Journal of Medicine, 348, p. 651-656.

57. Quiz 1
Q. How many moments for HAND
HYGIENE?

58. Q. When we will considered an infection
as SSI?
Quiz 2

59. Q. Elaboration of VAP?
Quiz 3

61. Thanks for your attention!!!