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Practical methods to control hospital acquired infections
- 1. Practical methods to control hospital acquired infections presented by : Faiqa ali chughtai
- 2. Case 1: • 1 yr old male child • Presented with fever, respiratory distress and stidor • Intubation was performed and dexamethasone was administered • After two days , child presented with signs and symptoms of aspiration pneumonia
- 3. Case 2: • A 5 months old male child • presented with a.w.d , severe dehydration & acute kidney dysfunction • Rehydration • For Kidney function monitoring urinary catheter was inserted • With in 36 hrs diarrhea was resolved, but patient showed signs of infection
- 4. Case 3 : • 5 years old female presented to hospital with fever , respiratory distress • 1st diagnosed as T.B pt , latter ruled out, ceftriaxone was prescribed and held latter diagnosed with pneumonia • Benzyl penicillin & co amoxicalve were prescribed • No improvement was found after 3 days ciprofloxacin was prescribed but in sub therapeutic dose, • Latter effusion n consolidation was diagnosed • and vancomycin ,tanzo and clarithromycin were added to regimen • after 20 days the microbe was found resistant to quinolones, aminoglycocides, microlides , beta lactam antibiotics. Only vancomycin was effective
- 5. Point to ponder ! • Similarity between these cases: • All were by inflicted by infections after admission to hospital
- 6. Conditions in our hospital
- 8. NOSOCOMIAL INFECTIONS • Hospital acquired infections / nosocomial infections. • The term "nosocomial" comes from two Greek words: • "nosus" meaning "disease" + "komeion" meaning "to take care of.“ • Hence, "nosocomial" should apply to any disease contracted by a patient while under medical care .
- 9. Definition According to WHO • 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. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility .
- 11. Who is responsible for noscocomial infections? 1 • Patient –for visiting hospital • for weak immunity 2 • Doctor-for prescribing antibiotics • For invasive procedures 3 • nurses-for not using aseptic procedures 4 • Hospital cleaners-for not being glued to mop & phenyl 5 • Microbes-for being there in 1st place Where is pharmacist in this chain? May be we are too busy in avoiding the blame
- 12. Factors effecting nosocomial infections Patient susceptibility • Endogenous infections • immunity • Normal flora • Malnutrition Iatrogenic • Treatment & intervention related • Anti microbial resistance • Involvement of pharmacist Microbial agents & organizational • Cross contaminations • Facilities • hygiene • Microbial flora of unit • Vectors of microbes • overcrowding
- 15. Strategy for control 1 • Take care of already present infections 2 • Control iatrogenic factors & AMR 3 • Establish infection control committee 4 5 • Define roles • Role of pharmacist 6 7 8 • Surveillance & policies • Training & education • Cleanliness & hygiene 9 • Control airborne , waterborne , infections 10 • Control vector of infection
- 16. Infection control committee • Involving management, physicians, other health care workers, clinical microbiology, pharmacy, central supply, maintenance, housekeeping, training services • must report directly to either administration or the medical staff to promote program visibility and effectiveness.
- 17. Review & approve surveillance policy ensure appropriate staff training Identify areas of intervention review risks associated with new devices & treatment Promote healthy pactice Provide input into investigatio n of epidemics Promote co-operation between health care providers and committees working in hospital
- 18. Management Physician & nurses Pharmacist • education and training • reviewing the nosocomial infections • Ensure authority of infection control team • Comply with infection control policies • Use aseptic techniques • Take proper med for infections they have • Promoting pharmaceutical preparations that prevent • transmission of infectious agents • Maintain relevant record of antimicrobials • Maintain appropriate storage
- 19. ROLE OF PHYSICIAN, MICROBIOLOGIST & PHARMACIST IN Control of AMR • Combine microbial sampling+biomarkers+diagnosis+treatment • Go for early diagnosis, early therapy within 48-72 hrs • Avoid longer stay at hospital • Go for de-escalation policy • Selective on basis of microbe • Decrease dose in acc. With infection condition • monotherapy
- 20. Control of nosocomial infections • 1st: treat present infections: • Treatment for resistant microbes Hospital acquired infection • Ceftriaxone • Imipenum • Ampi+salbactum Ampicillin resistant MRSA VRE enterococci • vancomycin • Linezolid,tigecycline
- 21. Do surveillance Make list of a.b Prescribe acc.to narrow spectrum Use prophylactic a.b if proved valuable •Perform antibiotic susceptibility test and monitor the trends in prevalence of bacterial resistance to antimicrobial agent. •Make list ,prescribe according to that. •Tailor list according to institutional microbial flora
- 22. Role of pharmacist Pharmaceutical preparations • obtain • Store • distribute Maintain record • Potency • Incompatibility • Storage conditions • Deterioration conditions Summary reports • Provide reports to • Antimicrobial use committee • Infection control committee
- 23. Concentration, Temperature Length of action Spectrum Toxic properties Incompatibilitie s Harmful effects Develop guidelines and products Monitor Q.C of sterilization procedures Therapy development Properties: Disinfection Info on antimicrobials Role of pharmacist Develop institution tailored therapy
- 24. ROLE OF NURSES & PHYSICIANS – Use of aseptic techniques while administering parental – Use of gloves, and hand washing practice – Use of no touch technique , as far as possible. – Keeping check of i/v & catheter inflicted infections – Ensure that housekeeping is performing its functions properly
- 25. DEVELOPMENT OF PERFORMANCE MANUALS • Infection control committee must develop manuals for , food providing services , housekeeping services , laundry services, hospital hygiene services • Organize surveillance program for nosocomial infections • Involve pharmacy in development of supervision program for use of anti infective drugs
- 26. Education & training • Organize teaching programs for medical , nursing , allied health personnel • Arrange courses for awareness of pharmacist so that they may supervise nursing staff for proper dispensing of medicines • Provide expert advice , analysis & leadership in outbreak investigation & control • Undertake research in hospital hygiene & infections
- 28. • Rates OF infection are obtained by dividing a numerator (number of infections or infected patients observed) by a denominator (population at risk, or number of patient-days of risk). The frequency of infection can be estimated by prevalence and incidence indicators
- 29. PHASES of nosocomial infections control • Surveillance • Policy development 1st phase 2nd phase • Implementation • Control measures • Hygiene protocols • Control of modes of transmission 3rd phase
- 30. Arrest of Modes of transmission Contact transmission • Droplet transmission Airborne transmission • Common vehicle transmission Vector borne transmission
- 31. Methods to control modes of transmission • Reducing person-to-person transmission • Hand decontamination • Safe injection administration • Preventing transmission from the environment
- 32. UTI SURGICAL SITE INFECTION MEASURES FOR CONTROL OF NOSOCOMIAL INFECTIONS PNEUMONIA VASCULAR DIVICE INFECTION
- 35. Guidelines for physicians, nurse & pharmacist • Wash hands promptly after contact with infective material • Use no touch technique wherever possible • Wear gloves when in contact with blood, body fluids, secretions, excretions, mucous membranes and contaminated items • Wash hands immediately after removing gloves • All sharps should be handled with extreme care
- 36. Guidelines • Clean up spills of infective material promptly • Ensure that patient-care equipment, supplies and linen contaminated with infective material is either discarded, or disinfected or sterilized between each patient use • Ensure appropriate waste handling • If no washing machine is available for linen soiled with infective material, the linen can be boiled.
- 37. Cleaning of the hospital environment • Zone a-no pt –normal domestic cleaning • Zone b-pt –non infected-not highly susceptibleno dry cleaning, use of detergent solutions • Zone c-infected pts-disinfectant/detergent solution, separate cleaning equipment for each unit • Zone d-highly susceptible pts-protected/ isolated-disinfectant/detergent solution, separate cleaning equipment for each unit
- 38. Sterilization & disinfection • Use of hot/superheated water • Disinfection with hot water • 1. Sanitary 80 °C 45–60 seconds equipment • 2. Cooking 80 °C 1 minute utensils • 3. Linen 70 °C 25 minutes 95 °C 10 minutes
- 39. Waterborne infections • • • • • • • Gram-negative bacteria: Pseudomonas aeruginosa Aeromonas hydrophilia Burkholderia cepacia Stenotrophomonas maltophilia Serratia marcescens Flavobacterium meningosepticum
- 40. Water born infections • • • • • • Acinetobacter calcoaceticus Legionella pneumophila and other Mycobacteria: Mycobacterium xenopi Mycobacterium chelonae Mycobacterium avium-intracellularae
- 41. Microbiological monitoring • Regulations for water analysis (at the national level for drinking-water, in the Pharmacopoeia for pharmaceutical waters) define criteria, levels of impurities, and techniques for monitoring. • Methods used for monitoring must suit the use. • Infections attributable to water are usually due to failure to meet water quality standards for the specific use. • Infection control/hygiene teams must have written, valid policies for water quality to minimize risk of adverse outcomes attributable to water in health care settings.
- 42. Airborne infections • • • • • • • Depend on : 1.Type of infections 2. Quality of air provided 3. Rate of air exchange 4. Number of persons present in wards 5. Movement of personnel 6. Level of compliance with infection control practices • 7. Quality of staff clothing • 8. Quality of cleaning process
- 43. Control of airborne infections • Appropriate ventilation is necessary, and must be monitored within risk areas, e.g. orthopedics, vascular surgery and neurosurgery. • Unidirectional airflow systems should be incorporated in appropriate areas in new hospital construction
- 44. Control of vectors • • • • • • • • Arthropods : Cockroaches are source of Streptococcus species Bacillus species (except Bacillus subtilis) Bacillus subtilis Staphylococcus aureus Staphylococcus epidermidis Enterococcus species Corynebacterium species
- 45. control of cockroaches • The keys to controlling cockroaches are sanitation and exclusion: cockroaches are likely to reinvade as long as a habitat is suitable to them (i.e., food, water, and shelter are available) • Sprays can be used to suppress the population
- 46. sterilization
- 47. Precautionary measures to avoid infections • traffic flow to minimize exposure of high-risk patients and facilitate patient transport • adequate spatial separation of patients • adequate number and type of isolation rooms • appropriate access to hand washing facilities • appropriate ventilation for isolation rooms and special patient care areas (operating theatres,transplant units) • preventing patient exposure to fungal spores with renovations
- 48. Final solution CO-ORDINATION & CO-OPERATION physician pharmacist nurses microbiologist Cleaning & housekeeping dpt
Editor's Notes
- dispensing anti-infectious drugs and maintainingrelevant records (potency, incompatibility,conditions of storage and deterioration)having available the following information ondisinfectants, antiseptics and other anti-infectiousagents:— active properties in relation to concentration,temperature, length of action, antibiotic spectrum— toxic properties including sensitization orirritation of the skin and mucosa— substances that are incompatible with antibioticsor reduce their potency— physical conditions which unfavourably affectpotency during storage: temperature, light,humidity— harmful effects on materials.
- Role of the hospital pharmacist (5)The hospital pharmacist is responsible for: obtaining, storing and distributing pharmaceuticalpreparations using practices which limitpotential transmission of infectious agents topatients dispensing anti-infectious drugs and maintainingrelevant records (potency, incompatibility,conditions of storage and deterioration) obtaining and storing vaccines or sera, and makingthem available as appropriate maintaining records of antibiotics distributed tothe medical departments providing the Antimicrobial Use Committee andInfection Control Committee with summary reportsand trends of antimicrobial use having available the following information ondisinfectants, antiseptics and other anti-infectiousagents:—(type ofappliances) and monitoring.
- organizing an epidemiological surveillance programmefor nosocomial infections participating with pharmacy in developing a programmefor supervising the use of anti-infectivedrugs
- ensuring patient care practices are appropriate tothe level of patient risk checking the efficacy of the methods of disinfectionand sterilization and the efficacy of systemsdeveloped to improve hospital cleanliness participating in development and provision ofteaching programmes for the medical, nursing,and allied health personnel, as well as all othercategories of staff providing expert advice, analysis, and leadershipin outbreak investigation and control participating in the development and operationof regional and national infection control initiatives the hospital hygiene service may also provideassistance for smaller institutions, and undertakeresearch in hospital hygiene and infection con
- patient day (P.D.), a unit in a system of accounting used by health care facilities and health care planners. Each day represents a unit of time during which the services of the institution or facility are used by a patient; thus 50 patients in a hospital for 1 day would represent 50 patient days. Evaluation of the surveillance strategyReview whether the surveillance system meets therequired characteristics (19,20): simplicity/flexibility/acceptance timeliness (is the feedback prompt enough to beuseful?) utility (in terms of priorities, impact, etc.) efficacy/efficiency
- Methods must be appropriate for the likelihoodof contamination, and necessary level of asepsis.This may be achieved by classifying areas intoone of four hospital zones (8):— Zone A: no patient contact. Normal domesticcleaning (e.g. administration, library).Zone B: care of patients who are not infected,and not highly susceptible, cleaned by a procedurethat does not raise dust. Dry sweepingor vacuum cleaners are not recommended. Theuse of a detergent solution improves the qualityof cleaning. Disinfect any areas withvisible contamination with blood or bodyfluids prior to cleaning.— Zone C: infected patients (isolation wards).Clean with a detergent/disinfectant solution,with separate cleaning equipment for eachroom.— Zone D: highly-susceptible patients (protectiveisolation) or protected areas such as operatingsuites, delivery rooms, intensive care units,premature baby units, casualty departmentsand haemodialysis units. Clean using a detergent/disinfectant solution and separate cleaningequipment
- Disinfection with hot waterTemperature Duration1. Sanitary 80 °C 45–60 secondsequipment2. Cooking 80 °C 1 minuteutensils3. Linen 70 °C 25 minutes95 °C 10 minutes