The document discusses hospital acquired (nosocomial) infections. It begins by explaining that patients in healthcare settings are at higher risk of infection than those at home. Healthcare-associated infection is now used instead of nosocomial to refer to all healthcare settings. One third of infections are acquired in hospitals. The causes include invasive devices, underlying patient conditions, and movement of medical staff between patients. Common sites of infection are the urinary tract, surgical wounds, and lungs. Strict hand hygiene and use of personal protective equipment are emphasized as the most important prevention methods.

1. Mrs. Babitha K Devu, Asstt. Professor
HOSPITAL ACQUIRED
(NOSOCOMIAL)
INFECTIONS

2. INTRODUCTION
MRS. BABITHA K DEVU 2
Patients in health care settings, especially
hospitals and long term care facilities, are at
a higher risk for infection than those patients
seen in the home.
Healthcare-Associated Infection is a term that
encompasses infections contracted in all
healthcare settings and is now used in place
of the older term, nosocomial infection,
which refers only to hospital acquired
infection.
The change in terminology is due to the
increasing infection rates and risks across
all healthcare settings.
1/3/2018

3. INTRODUCTION
MRS. BABITHA K DEVU 3
• Nosocomial infection comes
from Greek words “nosus”
meaning disease and “
komeion” meaning to take
care of
• Also called as HOSPITAL
ACQUIRED INFECTION
1/3/2018

4. Anton van Leeuwenhoek
(1632-1722)
• Dutch linen draper
• Amateur scientist
• Grinding lenses,
magnifying glasses,
hobby
• First to see bacteria
“little beasties”
• No link between
bacteria and disease
MICROBIOLOGY - SCIENTIFIC ERA
MRS. BABITHA K DEVU 41/3/2018

5. 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
SCIENTIFIC ERA CONTINUES ....
MRS. BABITHA K DEVU 51/3/2018

6. Louis Pasteur (1822-1895)
• French professor of
chemistry
• Studied how yeasts
(fungi) ferment wine and
beer
• Proved that heat
destroys bacteria and
fungi
• Proved that bacteria can
cause infection - the
“germ theory” of disease
SCIENTIFIC ERA CONTINUES ....
MRS. BABITHA K DEVU 61/3/2018

7. Joseph Lister (1827-1912)
• Scottish surgeon
• Recognised importance of
Pasteur’s work
• Concerned about infection
of compound fractures and
post-operative wounds
• Developed carbolic acid
spray to disinfect
instruments, patient’s skin,
surgeon’s skin
• Largely ignored by medical
colleagues
SCIENTIFIC ERA CONTINUES ....
MRS. BABITHA K DEVU 71/3/2018

8. Robert Koch (1843-1910)
• German general
practitioner
• Grew bacteria in
culture medium
• Showed which
bacteria caused
particular
diseases
• Classified most
bacteria by 1900
SCIENTIFIC ERA CONTINUES ....
MRS. BABITHA K DEVU 81/3/2018

9. DEFINING A NOSOCOMIAL INFECTION
• A nosocomial infection (nos-oh-koh-mi-al), which was
also known as a hospital-acquired infection or HAI, is
now replaced by Healthcare-Associated (Acquired)
Infection.
• When a patient develops an infection that was not
present or incubating at the time of admission to a
health care setting, it is called Healthcare-Acquired
Infections (HAI).
• A community-acquired infection is one that was present
at the time of admission to a health care setting.
MRS. BABITHA K DEVU 91/3/2018

10. WHEN YOU SAY HOSPITAL ACQUIRED
INFECTION
• Infection which was neither present
nor incubating at the time of admission
(i.e for 48 Hrs)
• Includes infection which only becomes
apparent after discharge from hospital
(i.e within 30days) but which was
acquired during hospitalisation
(Rcn, 1995)MRS. BABITHA K DEVU 101/3/2018

11. WHEN THE HOSPITAL
ACQUIRED INFECTIONS INCREASE
• Nosocomial infections are commonly transmitted
when hospital officials become complacent and
personnel do not practice correct hygiene
regularly.
• Patients often have multiple illnesses, are older
adults and are often poorly nourished.
• Lowered resistance to infection because of
underlying medical conditions
MRS. BABITHA K DEVU 111/3/2018

12. WHEN THE HOSPITAL
ACQUIRED INFECTIONS INCREASE
• Invasive treatment devices like IV catheters or
indwelling urinary catheters impair or bypass the
body’s natural defenses
• Treatment with multiple antibiotics for long
periods of time
• Medical staff move from patient to patient, the
staff themselves serve as a means for spreading
pathogens. Essentially, the staff act as vectors.
MRS. BABITHA K DEVU 121/3/2018

13. WHEN THE HOSPITAL
ACQUIRED INFECTIONS INCREASE
MRS. BABITHA K DEVU 131/3/2018

14. SOURCES OF
HOSPITAL ACQUIRED INFECTIONS
MRS. BABITHA K DEVU 14
1.Endogenous Infection – occurs when part of the patient’s
flora becomes altered and an overgrowth results (e.g.
Staphylococci, enterococci and streptococci) (50% of HAI is
endogenous)
Autoinfection ( Greatest source of potential danger)
2.Exogenous Infection – comes from microorganisms found
outside the individuals, such as Salmonella, Clostridium tetani.
(15% is exogenous) (Air-5%; Instruments-10%)
3.Cross Infection – From another Patient/Staff (35%)
1/3/2018

15. AGENTS OF NOSOCOMIAL INFECTIONS
VIRUS
BACTERIA
FUNGI
Virtually all microorganisms can cause nosocomial infections
15MRS. BABITHA K DEVU 1/3/2018

16. HAI - COMMON BACTERIA
• Staphylococci - wound,
respiratory and gastro-intestinal
infections
• Escherichia coli - wound and
urinary tract infections
• Salmonella - food poisoning
• Streptococci - wound, throat and
urinary tract infections
• Proteus - wound and urinary tract
infections (Peto, 1998)
MRS. BABITHA K DEVU 161/3/2018

17. • Hepatitis A -
infectious hepatitis
• Hepatitis B - serum
hepatitis
• Human
immunodeficiency
virus [HIV] - acquired
immunodeficiency
syndrome [AIDS]
(Peto, 1998)
HAI - COMMON VIRUSES
MRS. BABITHA K DEVU 171/3/2018

18. • Candida albicans -
Candidiasis
• Aspergillus –
Aspergillosis
HAI - COMMON FUNGI
MRS. BABITHA K DEVU 181/3/2018

19. MODES OF SPREAD
• Contact
• Vector borne
• Air borne
• Droplet
• Common vehicle
MRS. BABITHA K DEVU 191/3/2018

20. SPREAD - ENTRY AND EXIT
ROUTES
 Natural orifices - mouth, nose, ear, eye,
urethra, vagina, rectum
 Artificial orifices - such as tracheostomy,
ileostomy, colostomy
 Mucous membranes - which line most
natural and artificial orifices
 Skin breaks - either as a result of
accidental damage or deliberate
inoculation/incision.
MRS. BABITHA K DEVU 201/3/2018

21. SPREAD OF INFECTONS
The hands are the most important
vehicle of transmission of
HCAI
21MRS. BABITHA K DEVU 1/3/2018

22. •Common infections
• Urinary tract infections
• Surgical wound infections
• Lower respiratory infections
• Traumatic wounds and burns infections
• Primary bacteremia
TYPES OF INFECTIONS
22MRS. BABITHA K DEVU 1/3/2018

23. COMMON SITES OF INFECTION
23MRS. BABITHA K DEVU 1/3/2018

24. URINARY TRACT INFECTIONS
• It is the most common cause of
nosocomial infections
• 80% of the infections are
associated with indwelling
catheters.
24MRS. BABITHA K DEVU 1/3/2018

25. SURGICAL SITE INFECTIONS
• They are also frequent
• The definition is mainly clinical
(purulent discharge around wounds
or the insertion site of drain, or
spreading cellulites from wounds)
• The infections can be exogenously
or endogenously
25MRS. BABITHA K DEVU 1/3/2018

26. NOSOCOMIAL PNEUMONIA
• The most important are
patients on ventilators in ICU.
• Recent and progressive
radiological opacities of the
pulmonary parenchyma,
purulent sputum and recent
onsite fever.
26MRS. BABITHA K DEVU 1/3/2018

27. NOSOCOMIAL BACTERAEMIA
• The incidence is increasing
particularly for certain organisms
such as multi resistance coagulase
negative staphylococcus and candida.
• Infections may occurs at the skin
entry site of the IV device or in the
sub cutaneous path of catheter.
27MRS. BABITHA K DEVU 1/3/2018

28. PROBLEMS OF NOSOCOMIAL INFECTIONS
Nosocomial infections will become
more important as public health
problems as it causes,
• Nosocomial suffering
• Prolonged hospital stay
• Increase the cost of care
significantly
28MRS. BABITHA K DEVU 1/3/2018

29. SURVEILLANCE
MRS. BABITHA K DEVU 29
• Important means of monitoring HAI
Early detection of trends outbreaks
1. Laboratory Based
Microbiology Laboratory lists +ve
organisms
ICN reviews ‘Alert organisms’ reported
2. Ward Based
Ward staff monitor patients
ICN reviews ICN visits wards
1/3/2018

30. GENERAL PRINCIPLES IN PREVENTING HAI
MRS. BABITHA K DEVU 30
• Good general ward hygiene:
- No overcrowding
- Good ventilation
- Regular removal of dust
- Wound dressing early in day
- Disposable equipment
 HAND WASHING
most important -
Before and after patient contact
before invasive procedures
1/3/2018

31. UNIVERSAL INFECTION CONTROL
PRECAUTIONS
• Devised in US in the 1980’s in response to
growing threat from HIV and hepatitis B
• Not confined to HIV and hepatitis B
• Treat ALL patients as a potential bio-
hazard
• Adopt universal routine safe infection
control practices to protect patients, self
and colleagues from infection
MRS. BABITHA K DEVU 311/3/2018

32. UNIVERSAL PRECAUTIONS
• Hand washing
• Personal protective equipment [PPE]
• Preventing/managing sharps injuries
• Aseptic technique
• Isolation
• Staff health
• Linen handling and disposal
• Waste disposal
• Spillages of body fluids
• Environmental cleaning
• Risk management/assessment
MRS. BABITHA K DEVU 321/3/2018

33. PREVENTION AND CONTROL
Hand hygiene is
the
single most
important
measure for
control
of nosocomial
infections
33MRS. BABITHA K DEVU 1/3/2018

34. MANY PERSONNEL DON’T REALIZE WHEN
THEY HAVE MICROBES ON THEIR HANDS
• Healthcare workers can get 100s to 1000s of
bacteria on their hands by doing simple
tasks like:
• pulling patients up in bed
• taking a blood pressure or pulse
• touching a patient’s hand
• rolling patients over in bed
• touching the patient’s gown or bed sheets
• touching equipment like bedside rails, overbed tables, IV
pumps
Casewell MW et al. Br Med J 1977;2:1315
Ojajarvi J J Hyg 1980;85:193
MRS. BABITHA K DEVU 341/3/2018

35. WHY WE ARE NOT WASHING
HANDS ???
• Working in high-risk areas
• Lack of hand hygiene promotion
• Lack of role model
• Lack of institutional priority
• Lack of sanction of non-compliers
MRS. BABITHA K DEVU 351/3/2018

36. 36MRS. BABITHA K DEVU 1/3/2018

37. HAND HYGIENE TECHNIQUES
1. Alcohol hand rub
2. Routine hand wash 10-15 seconds
3. Aseptic procedures 1 minute
4. Surgical wash 3-5 minutes
1/3/2018 37MRS. BABITHA K DEVU

38. ALCOHOL HAND RUBS
• Require less time
• Can be strategically placed
• Readily accessible
• Multiple sites
• All patient care areas
1/3/2018 38MRS. BABITHA K DEVU

39. ALCOHOL HAND RUBS
• Acts faster
• Excellent bactericidal activity
• Less irritating (??)
• Sustained improvement
1/3/2018 39MRS. BABITHA K DEVU

40. ALCOHOL HAND RUBS
Choose agent carefully:
• Adequate antimicrobial efficacy
• Compatibility with other hand hygiene
products
1/3/2018 40MRS. BABITHA K DEVU

41. VISIBLE SOILING
Hands that are visibly
soiled or potentially grossly
contaminated with dirt or
organic material MUST by
washed with liquid soap
and water
1/3/2018 41MRS. BABITHA K DEVU

42. AREAS MOST FREQUENTLY MISSED
HAHS © 1999 1/3/2018 42MRS. BABITHA K DEVU

43. MRS. BABITHA K DEVU 431/3/2018

44. HAND CARE
• Nails
• Rings
• Hand creams
• Cuts & abrasions
• “Chapping”
• Skin Problems
1/3/2018 44MRS. BABITHA K DEVU

45. PERSONAL PROTECTIVE
EQUIPMENT
• PPE when contamination or splashing with blood
or body fluids is anticipated
• Disposable gloves
• Plastic aprons
• Face masks
• Safety glasses, goggles, visors
• Head protection
• Foot protection
• Fluid repellent gowns
MRS. BABITHA K DEVU 451/3/2018

46. Wear Personal Protective Equipments
They are worn for two reasons:
Provide a protective barrier and
prevent contamination of hands
Reduce the likelihood that
microorganism present on the
hands will be transmitted to the
patients during invasive and
other patient care procedure.
46MRS. BABITHA K DEVU 1/3/2018

47. WEAR APRONS
• Wearing an apron during patient
care reduces the risk of infections.
• Apron is must for preventing
yourself from getting disease.
47MRS. BABITHA K DEVU 1/3/2018

48. • Prevention
• correct disposal in
appropriate container
• avoid re-sheathing needle
• avoid removing needle
• discard syringes as single
unit
• avoid over-filling sharps
container
• Management
• follow local policy for
sharps injury (May, 2000)
SHARPS INJURIES
MRS. BABITHA K DEVU 481/3/2018

49. ASEPTIC TECHNIQUE
• Sepsis - harmful infection by bacteria
• Asepsis - prevention of sepsis
• Minimise risk of introducing pathogenic micro-
organisms into susceptible sites
• Prevent transfer of potential pathogens from
contaminated site to other sites, patients or
staff
• Follow local policy of your hospital
MRS. BABITHA K DEVU 491/3/2018

50. • Disinfect clean skin
with an appropriate
antiseptic before
insertion and at the
time of dressing
changes.
• A 2% chlorhexidine
is preferred.
SKIN ANTISEPSIS: A 2 STEP
PROCESS
MRS. BABITHA K DEVU 501/3/2018

51. Sterilization
Sterilization of all reusable equipments
such as ventilator, humidifier and
any device that come in contact
with the respiratory tract.
PREVENTION AND CONTROL
51MRS. BABITHA K DEVU 1/3/2018

52. PREVENTION AND CONTROL
Prevention and control of nosocomial
infections can be done by the
following ways,
ISOLATION
Designed to prevent transmission of
microorganisms by common routes in
hospitals. Because agent and host
factors are more difficult to control,
interruption of transfer of
microorganisms is directed primarily
at transmission.
52MRS. BABITHA K DEVU 1/3/2018

53. ISOLATION
• Single room or group
• Source or protective
• Source - isolation of infected patient
• mainly to prevent airborne transmission via
respiratory droplets
• respiratory MRSA, pulmonary tuberculosis
• Protective - isolation of immune-suppressed
patient (May, 2000)
• Significant psychological effects
(Davies et al, 1999)
MRS. BABITHA K DEVU 531/3/2018

54. STAFF HEALTH
• Risk of acquiring and transmitting infection
• Acquiring infection
• immunisation
• cover lesions with waterproof dressings
• restrict non-immune/pregnant staff
• Transmitting infection
• advice when suffering infection
• Report accidents/untoward incidents
• Follow local policy (May, 2000)
MRS. BABITHA K DEVU 541/3/2018

55. LINEN HANDLING AND DISPOSAL
• Bed making and linen changing techniques
• Gloves and apron - handling contaminated
linen
• Appropriate laundry bags
• Avoid contamination of clean linen
• Hazards of on-site ward-based laundering
• NHS Executive guidelines (1995)
• Follow local policy of your hospitalMRS. BABITHA K DEVU 551/3/2018

56. WASTE DISPOSAL
• Clinical waste - HIGH risk
• potentially/actually contaminated waste including body
fluids and human tissue
• yellow plastic sack, tied prior to incineration
• Household waste - LOW risk
• paper towels, packaging, dead flowers, other waste
which is not dangerously contaminated
• black plastic sack, tied prior to incineration
• Follow local policy of your Hospitals
MRS. BABITHA K DEVU 561/3/2018

57. SPILLAGE OF BODY FLUIDS
• PPE - disposable gloves, apron
• Soak up with paper towels, kitchen roll
• Cover area with hypochlorite solution e.g.,
Milton, for several minutes
• Clean area with warm water and
detergent, then dry
• Treat waste as clinical waste - yellow
plastic sack
• Follow local policy (May, 2000)
MRS. BABITHA K DEVU 571/3/2018

58. ENVIRONMENTAL CLEANING
• Recent concern regarding poor hygiene in
hospital environments (NHSE, 1999)
• Some pathogens survive for long periods
in dust, debris and dirt
• Poor hygiene standards - hazardous to
patients and staff (May, 2000)
• Report poor hygiene to Domestic Services
(UKCC, 1992)
• “Hospitals should do the sick no harm”
(Nightingale, 1854)
MRS. BABITHA K DEVU 581/3/2018

59. RISK ASSESSMENT
• No risk of contact/splashing with blood/body fluids - PPE
not required
• Low or moderate risk of contact/splashing - wear gloves
and plastic apron
• High risk of contact/splashing - wear gloves, plastic
apron, gown, eye/face protection (Rcn, 1995)
• Cerebrospinal fluid, peritoneal fluid, pleural fluid,
synovial fluid, amniotic fluid, semen, vaginal secretions,
and
• Any other fluid containing visible blood e.g., urine, faeces
(Rcn, 1995)
MRS. BABITHA K DEVU 591/3/2018

60. TELL YOUR DOCTOR EVERYTHING
• All symptoms
• Previous disease
• Other alternative treatment
• Other over the counter
medication
60MRS. BABITHA K DEVU 1/3/2018

61. Get educated
Learn about your conditions and
treatment is the best way to
prevent an error.
Get involved
Be assertive about your rights
To be a part of the decision
Process for your medical care
61MRS. BABITHA K DEVU 1/3/2018

62. • Preventing HCAI is a very important aspect of patient safety
• All health care personnel must practice the highest standards
of infection control as HCAIs
Cause significant morbidity and mortality to patients and
health care staff
Contribute to increasing prevalence of antibiotic resistance
Are difficult and expensive to manage
Can result in medical litigation
CONCLUSION
62MRS. BABITHA K DEVU 1/3/2018

63. • There is no official national approach and
no real managerial support from
authorities for nosocomial infection
• Only thing is proper asepsis, proper hand
washing and sterilization.
CONCLUSION
63MRS. BABITHA K DEVU 1/3/2018

64. ANY QUESTIONS???
• Thank you for not asking!!!
1/3/2018 64MRS. BABITHA K DEVU

65. 65MRS. BABITHA K DEVU 1/3/2018