NOSOCOMIAL INFECTION OR HOSPITAL ACQUIRED INFECTION
OR HEALTHCARE ASSOCIATED INTECTION CAN BE DEFINED AS THE INFECTION ACQUIRED IN THE HOSPITAL BY A PATIENT:
WHO WAS ADMITTED FOR A REASON OTHER THAT INFECTION
FACTORS AFFECTING HAIS
SOURCES OF INFECTION
MICRORGANISMS RESPONSIBLE FOR INFECTION
TYPES OF HAIS
MODE OF TRANSMISSION
PREVENTION OF HAIS
A nosocomial infection is contracted because of an infection or toxin that exists in a certain location, such as a hospital. People now use nosocomial infections interchangeably with the terms health-care associated infections (HAIs) and hospital-acquired infections. For a HAI, the infection must not be present before someone has been under medical care.
The most common types of HAIs are:
-urinary tract infections (UTIs)
surgical site infections
-gastroenteritis
-meningitis
-pneumonia
A basic idea about Hospital Acquired Infections from a Preventive and Social Medicine Student's point of view. It has many pictures -some were indeed taken from Slide Share itself! I think I can do it since there is a "share" in Slide share :)
A nosocomial infection is contracted because of an infection or toxin that exists in a certain location, such as a hospital. People now use nosocomial infections interchangeably with the terms health-care associated infections (HAIs) and hospital-acquired infections. For a HAI, the infection must not be present before someone has been under medical care.
The most common types of HAIs are:
-urinary tract infections (UTIs)
surgical site infections
-gastroenteritis
-meningitis
-pneumonia
A basic idea about Hospital Acquired Infections from a Preventive and Social Medicine Student's point of view. It has many pictures -some were indeed taken from Slide Share itself! I think I can do it since there is a "share" in Slide share :)
Infections that develop within a hospital or are produced by microorganisms, acquired during hospitalization, within 48hrs.
Also called as “NOSOCOMIAL INFECTIONS.”
Over 1.4 million people each year worldwide suffer from hospital acquired infections. We can follow simple steps and protocols to prevent many of these cases.
Hospital acquired infections: The different common sources of infection, their routes of spread and the growing antimicrobial resistance. Also includes a discussion on hospital Infection prevention and control guidelines and the universal and standard precautions.
Nosocomial Infections by Mohammad MufarrehMMufarreh
Reviews the definition, risk factors, types, sources, causes, and modes of transmission of healthcare-associated infections and the preventive measures that can be applied to minimize the risks.
this presentation is help to the student for the getting information regarding the sorces, types, & mode of infection spread in the hospital sector, it help firstd year student student gain the information regarding through this ppt
Infections that develop within a hospital or are produced by microorganisms, acquired during hospitalization, within 48hrs.
Also called as “NOSOCOMIAL INFECTIONS.”
Over 1.4 million people each year worldwide suffer from hospital acquired infections. We can follow simple steps and protocols to prevent many of these cases.
Hospital acquired infections: The different common sources of infection, their routes of spread and the growing antimicrobial resistance. Also includes a discussion on hospital Infection prevention and control guidelines and the universal and standard precautions.
Nosocomial Infections by Mohammad MufarrehMMufarreh
Reviews the definition, risk factors, types, sources, causes, and modes of transmission of healthcare-associated infections and the preventive measures that can be applied to minimize the risks.
this presentation is help to the student for the getting information regarding the sorces, types, & mode of infection spread in the hospital sector, it help firstd year student student gain the information regarding through this ppt
any infection developing in a patient after
two days of hospitalization can be labelled as healthcare-associated infection (HAI)or hospital Aquired infection . Among them, there are four
major types which are commonly encountered and
therefore need to be discussed in detail. These are also the
HAIs for which surveillance is recommended.
1. Catheter-associated urinary tract infection (CAUTI)
2. Catheter-related bloodstream infection (CRBSI)
3. Ventilator-associated pneumonia (VAP)
4. Surgical site infection (SSI).
Out of these, the first three (CAUTI, CRBSI, VAP) are
together called as device associated infections (DAIs).
The hospital-acquired infections or nosocomial infections are those infections developed in hospitalized patients who were neither infected nor were in incubation at the time of their admission.
Preventing Hospital-Acquired Infections: Best Practices and StrategiesVamsi kumar
These notes will provide an overview of hospital-acquired infections (HAIs) and the importance of preventing them. We will discuss the common types of HAIs, such as surgical site infections, bloodstream infections, and urinary tract infections, as well as the factors that contribute to their occurrence. Additionally, we will explore various strategies and best practices for preventing HAIs, such as hand hygiene, environmental cleaning, and antibiotic stewardship programs. The notes will also cover the roles of healthcare providers, patients, and hospital administrators in preventing HAIs and the importance of communication and collaboration between all stakeholders. Overall, these notes will be a comprehensive guide to reducing the incidence of HAIs and improving patient safety in healthcare settings.
Pathogenic microorganisms proliferate and invade bodily tissue, causing tissue harm and disease.
The invasion and multiplication of microorganisms such as bacteria, viruses, and parasites those are not normally present within the body.
An infection may cause no symptoms and be subclinical, or it may cause symptoms and be clinically apparent.
An infection may remain localized, or it may spread through the blood or lymphatic vessels to become systemic (body wide).
Microorganisms that live naturally in the body are not considered infections.
For example, bacteria that normally live within the mouth and intestine are not infections.
Infection prevention policies and practices are used in hospitals and other health care facilities to reduce the spread of infections.
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.
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LABORATORY DIAGNOSIS OF VIRAL INFECTIONS.pdfWani Insha
Laboratory diagnosis of viral infections is useful for the following purposes:
To start antiviral drugs for those viral infections for which specific drugs are available such as herpes, CMV, HIV, influenza and respiratory syncytial virus (RSV)
Screening of blood donors for HIV, hepatitis B and hepatitis C-helps in prevention of transfusion transmitted infections
Surveillance purpose: To assess the disease burden in the community by estimating the prevalence and incidence of viral infections
For outbreak or epidemic investigation, e.g. influenza epidemics, dengue outbreaks-to initiate appropriate control measures
To start post-exposure prophylaxis of antiretroviral drugs to the health care workers following needle stick injury.
To initiate certain measures: For example,
If rubella is diagnosed in the first trimester of pregnancy, termination of pregnancy is recommended
If newborn is diagnosed to have hepatitis B infection, then immunoglobulins (HBIG) should be started within 12 hours of birth.
PHLEBOTOMY
The process of collecting a blood sample is called
phlebotomy
This procedure is also known as Venipuncture
A person who performs phlebotomy is called a
phlebotomist, although doctors nurses, and medical
laboratory scientists.
BLOOD SPECIMEN COLLECTION AND PROCESSING
The first step in acquiring a quality lab. Test result for any
patient is the specimen collection procedure.
Blood specimen are obtained through capillary skin puncture
(finger, toe, heel), arterial , venous sampling.
VENIPUNCTURE
Venipuncture is the process of obtaining blood samples from veins
for lab testing
VENIPUNCTURE PROCEDURE STEPS
STEP 1:- Preparation of specimen collection material:
Following material should be readily available in the specimen
collection section-
Disposable syringes and needles or vacutainer systems.
Disposable lancets
Gauze pads or cotton
Tourniquet
70% (V/V) ethanol
Clean and dry wide mouth bottles
Leak- proof transportation bags and containers
A puncture-resistant sharp container
Blood collection tubes
VENIPUNCTURE PROCEDURE STEPS
STEP 1: Preparation of specimen collection material:
Sterile glass or plastic tubes with rubber caps
Vacuum-extraction blood tubes
Glass tubes with screw caps
Sterile glass or bleeding pack (collapsible) if large
quantities of blood are to be collected
well-fitting, non-sterile gloves
Laboratory specimen labels
Writing equipment
Laboratory forms
ORDER OF DRAW
To avoid cross-contamination, blood must be drawn and collected in
tubes in a specific order. This is known as the Order of Draw.
Blood culture
Blue tube for coagulation (Sodium Citrate)
Red No Gel
Gold SST (Plain tube w/gel and clot activator additive)
Green and Dark Green (Heparin, with and without gel)
Lavender (EDTA)
Pink - Blood Bank (EDTA)
Gray (Oxalate/Fluoride)
Black ( ESR)
VENIPUNCTURE PROCEDURE STEPS
Step 2:- Patient preparation:
Following instruction is given to the patient
patient should be on balanced diet at least for 2 to 3 days prior
to the test.
The day before sample collection, the patient should not drink
intoxicating substance, esp. alcoholic drinks and eat tobacco.
Patient should report to the lab. After fasting for 8-12 hrs.
Patient should not drink tea, or coffee or any other drinks
except one glassful of water.
VENIPUNCTURE PROCEDURE STEPS
Step 2 – Identify and prepare the patient
Where the patient is adult and conscious, follow the steps
outlined below.
Introduce yourself to the patient, and ask the patient to state their
full name.
Check that the laboratory form matches the patient’s identity (i.e.
match the patient’s details with the laboratory form, to ensure
accurate identification).
Ask whether the patent has allergies, phobias or has ever fainted
during previous injections or blood draws.
If the patient is anxious or afraid, reassure the person and ask what
would make them more comfortable.
capillary method
aretial method
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Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
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2. Definition
Hospital acquired infections or nosocomial infections or
healthcare-associated infections (HAis) can be defined as the
infections acquired in the hospital by a patient:
who was admitted for a reason other than that infection
In whom the infection was not present or incubating at the
time of admission
Symptoms should appear at least after 48 hours after
admission
This include infections acquired in the hospital but appearing
after discharge, and also occupational infections among staff
of the hospital care facility
HOSPITAL ACQUIRED INFECTIONS (HAIS)
2
3. The principal factors that determine the likelihood that a given
patient would acquire a nosocomial infection are:
Immune status: Most admitted patients have impaired immunity
either as a part of their preexisting disease processes or, in
some instances, due to the treatment they have received in the
hospital.
Hospital environment: the hospital environment harbors a
greater magnitude of microorganisms than that of community.
Transmission of these organisms to the patients can cause
nosocomial outbreaks of infection.
FACTORS AFFECTING HAIS
3
4. Hospital organisms: Most of the organisms present in the
hospital environment are multidrug resistant. this is because
of the increased antibiotic usage in the hospital.
the minor population of resistant organisms present initially
flourish in presence of constant antibiotic pressure and slowly
replace the susceptible strains in die hospital.
FACTORS AFFECTING HAIS
4
5. Diagnostic or therapeutic interventions such as insertion of
intravenous or urinary catheters, or endotracheal tube, may
introduce infection in susceptible patients; most of which are
due to the patient's endogenous flora
Transfusion: Blood, blood products and intravenous fluids
used for transfusion, if not properly screened, can transmit
many blood borne infections (BBI) such as HIV, Hepatitis B
and C viruses.
Poor hospital administration: Strong administrative support is
essential to control the Hals; failing of which promote the
spread of HAls.
FACTORS AFFECTING HAIS
5
6. Endogenous Source
The majority of nosocomial infections are endogenous in
origin, i.e. they involve patient's own microbial flora which
may invade the patient's body during some surgical or
instrumental manipulations.
Exogenous Source
Exogenous sources are from hospital environment, staff, or
patients.
SOURCES OF INFECTION
6
7. Environmental sources include inanimate objects, air, water
and food in the hospital.
Inanimate objects in the hospital are medical equipment's
(endoscopes, catheters, etc.), bed pans, surfaces
contaminated by patients' excretions, blood and body fluid.
Healthcare workers may be potential carriers, harboring many
organisms; which may be multidrug resistant, e.g. nasal
carriers of Methicillin-resistant Staphylococcus aureus
(MRSA).
Other patients of the hospital may also be the source of
infection
SOURCE OF INFECTION
7
8. Hospital acquired infections can be caused by almost any
microorganism, but those that survive in the hospital
environment for long periods and develop resistance to
antimicrobials and disinfectants are particularly important.
The ESKAPE pathogens: They are responsible for a
substantial percentage of nosocomial infections in the
modern era and represent the vast majority of multidrug
resistant isolates present in a hospital.
Enterococcus faecium
Staphylococcus aureus
Klebsiella pneumoniae
Acinetobacter baumannii
Pseudomonas aeruginosa
Enterobacter species
MICROORGANISMS IMPLICATED IN HAIS
8
9. Other infections that can spread in hospitals include:
Escherichia coli
Nosocomially acquired Mycobacterium tuberculosis
Legionella pneumophila
Candida albicans
Clostridium difficile diarrhea
MICROORGANISMS IMPLICATED IN HAIS
9
10. Microorganisms spread in the hospital through several modes
Contact transmission
Direct contact: Skin to skin contact and thereby physical
transfer of microorganisms between a susceptible host and an
infected or colonized person (usually healthcare workers,
rarely other patients)
Indirect contact: this involves contact of a susceptible host
with contaminated inanimate objects such as:
Dressings, or gloves, instruments (e.g. stethoscope)
Parenteral transmission through: Needle or sharp prick Injury,
splashes of blood or body fluids or excretions, contaminated saline
flush, .syringes, vials and bags
MODES OF TRANSMISSION
10
11. Inhalation mode
Droplet transmission: Droplets of >5 µm size can travel for
shorter distance (< 3 feet)
Droplets generated from the infected person while coughing.
sneezing and talking are propelled for a short distance
through the air and deposited on the host's body.
This is an important mode of transmission of agents causing
bacterial meningitis, diphtheria, and RSV etc
MODES OF TRANSMISSION
11
12. Inhalation mode
Airborne transmission: This refers to the airborne droplet
nuclei ( 5 µm size) or dust particles that remain suspended in
the air for long time and can travel longer distance
This is more efficient mode than droplet transmission.
Microorganisms transmitted by airborne transmission include
Legionella, Mycobacterium tuberculosis, measles and
varicella-zoster viruses.
MODES OF TRANSMISSION
12
13. Vector borne transmission: Via 'Vectors such as mosquitoes,
flies, etc carrying the microorganisms.
This is a rare mode of transmission In hospital.
Common vehicle transmission: such as food, water, devices
and equipment's
MODES OF TRANSMISSION
13
14. In any hospital the four most common HAIs encountered are:
Urinary tract infections (UTIs) (33%)
Pneumonia (15%)
Surgical site infections (15%)
Blood stream infections ( 13%)
TYPES OF HAIS
14
15. Urinary tract infections account for the majority of HAis.
Risk factors that predispose patients to acquire a nosocomial
UTI include-
Advanced age,
Female gender,
Severe underlying disease,
Placement of a urinary catheter.
Organisms: Gram-negative rods cause the majority of hospital acquired
UTIs and E. coli is the number one organism implicated. Gram-positive
bacteria and Candida cause the remainder of the infections.
URINARY TRACT INFECTIONS (UTIS)
15
16. lung infections are the major cause of HAIs after UTI.
Risk factors to develop nosocomial pneumonia are
advanced age,
chronic lung disease,
aspiration of upper respiratory tract secretions into the lungs,
semiconscious patient,
chest surgeries
mechanical ventilation through intubation of endotracheal tube
(ventilator-associated pneumonia)
Organisms: Gram-negative rods and S. aureus, account for majority of
infections of the patients from the hospital
PNEUMONIA
16
17. Surgical site infections (SSI) are defined as infections that
develop at the surgical site within 30 days of the surgery.
Organisms: Surgical site wounds are classified as clean,
clean-contaminated, contaminated or dirty.
For clean wound: The skin flora of the surgery team or the
environmental organisms are the major pathogens; most
common being S. aureus.
For other types: The patients endogenous flora (anaerobes
and gram-negative rods) are the common agents.
SURGICAL SITE INFECTIONS
17
18. Risk factors for nosocomial wound infection include:
Advanced age,
Obesity,
Malnutrition,
Diabetes,
Infections at a remote site that spread through blood stream
Time interval between pre-operative shaving of the site and
the surgery-if exceeds more than 12 hours.
SURGICAL SITE INFECTIONS
18
19. Nosocomial blood stream infections are the fourth common
cause of HAIs.
Organisms: Coagulase negative staphylococci, S. aureus and
enterococci are increasingly reported recently followed by
gram- negative rods and Candida.
Risk factors that predispose the patients to acquire a
nosocomial bloodstream infection include:
Age ( <1 years and >60 years), and malnutrition
Low immunity or severe underlying disease
loss of skin integrity (burn or bed sore)
Prolonged hospital stay, especially in ICUs
Presence of intravascular catheters
BLOOD STREAM INFECTIONS
19
20. Standard (Routine) Precautions
Standard precautions are a set of infection control practices
used to prevent transmission of diseases that can be acquired
by contact with blood, body fluids, non-intact skin (including
rashes), and mucous membranes. These measures should be
followed when providing care to:
All individuals, whether or not they appear infectious/
symptomatic or not.
All specimens (blood or body fluids) whether they appear
infectious or not.
All needles and sharps whether they appear infectious or not.
PREVENTION OF HAIS
20
21. Components of standard precautions include:
Hand hygiene:
Wash hands promptly after contact with infective material
Use no touch technique wherever possible
Personal protective equipment's (PPEs):
Wear gloves when expecting contact with blood, body fluids,
secretions, excretions, mucous membranes and contaminated
items and wash hands immediately after removing gloves.
Sharp handling: AII sharps should be handled with extreme care
Spillage cleaning: Clean up spills of infective material promptly
Waste handling: Ensure appropriate biomedical waste
seggregation and disposal
21
22. Specific precautions
Additional precautions are needed for preventing specific
modes of transmission.
Airborne Precautions
the following measures are required:
Individual room should be provided with adequate ventilation
with negative pressure facility.
Staff should wear high-efficiency masks in room
Patient should be confined to the room.
PREVENTION OF HAIS
22
23. Droplet Precautions
The following procedures are required:
Individual room for the patient, if available
Mask for healthcare workers
Restricted movement of the patient; patient wears a surgical
mask while leaving the room.
PREVENTION OF HAIS
23
24. Contact Precautions
These are required for patients with enteric infections and
diarrhea which cannot be controlled, or skin lesions which can
not be contained.
Individual room for the patient if available; cohorting of patients
if possible
Staff should wear gloves and gowns on entering the room.
Hand washing should be done before and after contact with the
patient, and on leaving the room.
Appropriate environmental and equipment cleaning,
disinfection, and sterilization to be followed.
PREVENTION OF HAIS
24
25. Precautions for Patients with MDROs
The increased occurrence of multidrug resistant organisms
(MDROs) is a major medical concern. the spread of MDROs
such as multidrug resistant MRSA is usually by transient
carriage on the hands of healthcare workers.
The following precautions are required for the prevention of
spread of epidemic of MRSA:
Minimize ward transfers of staff and patients
Ensure early detection of cases, especially if admitted from
another hospital; screening of high risk patients may be
considered
PREVENTION OF HAIS
25
26. Precautions for Patients with MDROs
Isolate infected or colonized patients in a single room,
isolation unit or cohorting in a larger ward
Reinforce hand washing by staff after contact with infected
or colonized patients
Use gloves, gown or apron for handling MRSA contaminated
materials, or infected or colonized patients
Consider treating nasal carriers with mupirocin
Consider daily wash or bath by antiseptic detergents for
carriers or infected patients.
Ensure careful handling and disposal of medical devices.,
linen, waste, etc.
Develop guidelines specifying when isolation measures can
be discontinued.
PREVENTION OF HAIS
26