based on infections aquired from the hospital and its prevention

1. HOSPITAL AQUIRED
INFECTIONS
BY :-
Dr SMITA PADHI

2. WHAT IS HAI??
• An infection 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 atleast 48-72 hrs after admission
• Also includes infection acquired in the hospital but appearing after
discharge
• Occupational infection among staff of hospital care facility.

3. FACTORS THAT PROMOTES INFECTION:-
1. Decrased immunity
2. Increase in the variety of medical procedure and other invasive
techniques
3. Drug resistant bacteria transmission’
4. Transfusion’
5. Poor administration

4. FREQUENCY OF INFECTION :-
• Appears worldwide – both developed and resource
poor countries
• Most frequent are
1. Surgical site wound infection
2. Uti
3. Lrti
• More prevalent in
1. Icu
2. Surgical ward and orthopaedic ward
3. Burn wards
• Infection rates are higher in
1. Old aged
2. Underlying disease
3. Chemotherapy
4. Organ transplants

5. SOURCES OF INFECTION:-
• Endogenous source – mostly all HAI are endogenous
• Exogenous –
1. Hospital environment
2. Hospital staff
3. Patients

6. IMPACT ON NOSOCOMIAL INFECTION:-
• Adds up functional disability and emotional stress
• Leads to disabling condition that reduces quality of life.
• Increases hospital stay
• Usage of drugs
• Need of isolation
• Additional lab and other diagnostic tests.
• Transmission of organisms to the community after discharge.

7. FACTORS INFLUENCING DEVELOPMENT
OF HAI:-
1. Microbial agent
2. Patients susceptibility
3. Environmental factors
4. Bacterial resistance

8. MODE OF TRANSMISSION OF HAI:-
1. Contact transmission
• Direct contact
• Indirect contact
2. Inhalational mode
• Droplet transmission
• Airborne transmission
3. Vector born transmission
4. Common vehicle transmission

9. TYPES AND SYMPTOMS OF HAI:-
Common organisms causing
•UTI – E.coli, ocassionally gram positive
bacterias
Also candida
• Respiratory inf – Gnb , S.aureus.
•Surgical site inf –
1. clean wound – skin flora (surgical team).
Environmental organisms – S.aureus.
2. other wounds – endogenous flora –
anaerobes , gnb.
•Blood stream inf – staphylococci , S.aureus ,
enterococci.

10. OTHER HAI:-
• Skin and soft tissue infection
• Gastroenteritis
• Sinusitis
• Endometritis

12. BACTERIA:-
• Commensal bacteria – Staphylococcus  iv line infection
E.coli  UTI
• Pathogenic bacteria –
1. anaerobic gram positive rods - clostridium causing gangrene.
2. aerobic gram positive bacteria – S.aureus causing lung , bone ,
heart , blood stream infections.
3. gram negative bacteria – Enterobacteriacae – E.coli , Proteus ,
Klebsiella, Enterobacter, Serratia marcescens causing UTI ,
Cannula insertion site infection. Serious infections like bacteremia
, peritoneum inf. Lungs inf. Surgical site inf.
4. Pseudomonas
5. Selected other bacterias such as Legionella causing pneumonia

13. VIRUSES
• Hep B and Hep C – dialysis, injections, transfusions, endoscopy
• Rota virus
• Respiratory syncytial virus
• Entero virus
• Cytomegalovirus ,
• Hiv
• Ebola
• Influenza
• Herpes simplex
• Varicella zoster

14. Parasites and Fungi
• Parasites :-
1. Giardia Lambia
2. Sarcoptus scabies – ectoparasite – outbreaks in hospital
• Fungi :-
1. Candida albicans
2. Aspergillus
3. Cryptococcus neoformans
4. Crypto sporidium

16. PREVENTION OF HAI:-
REQUIRES INTEGRATED MONITORED PROGRAMME THAT INCLUDES
–
1. adequate hand washing , glove use, aseptic practice , isolation
strategies , laundary , sterilisation and disinfection practice
2. Controlling environmental risk for infection
3. Appropiate use of prophyllactic antimicrobials , nutrition and vaccination.
4. Minimising invasive procedure
5. Survillance , identifying and controlling outbreaks
6. Prevention of infection among staffs
7. Enhancing staff – patient care practices and educating staffs about
HAI’s

19. RISK STRATIFICATION
• Acquisition determined by both patient factor such as degree of
immunocompromise and interventions perfomed which increases the risk.
• Risk assesment will be helpful to categorise the patient
• Risk of diff patient group :-
Risk of infection Type of patient Type of procedure
Minimal Non compromised , no significant underlying disease Non invasive. No exposure to
biological fluid
Medium Infected patients / patient with some risk factors Exposure to biological fluid/
invasive non surgical procedure like
catheterisation etc.
High Infectious patients /multiple trauma / severe burn
/organ transplant
Surgery / high risk procedure
/invasive procedure

20. Aseptic measures applied for different level of risk
of infection:-
Risk of infection Asepsis Antiseptics Hands Clothes Dresses
Minimal Clean None Simple hand
washing /hand rub
Street clothes Clean /
disinfected at
informed or low
level
Medium Asepsis Standard
antiseptic
procedure
Hyeginic hand
washing /hand
disinfectant
Protection
against blood or
body fluid
Disinfected at
sterile or higher
level
High Surgical
sepsis
Specific products Surgical hand
washing
/disinfectant by
rubbing
Dress mask cap
gloves
Disinfected at
sterile or higher
level

21. HOW TO REDUCE PERSON
TO PERSON
TRANSMISSION

22. 1.Hand decontamination
•Wash hands properly after contact with infective material.
•Use no touch technique wherever posssible.
Optimal hand hyegine requirenments:-
• For hand washing
1. Running water
2. Product
3. Facilities for drying without contamination.
• For hand disinfection
1. Specific hand disinfectant

23. Procedure of Hand washing
• Jewelleary to be removed before washing.
• Simple hygiene – hand and wrist.
• Surgical procedure – hand and forearm.
•TYPES OF HAND WASH:-
1. For routeine care
2. Antiseptic hand cleaning
3. Surgical scrub

24. STEPS OF HANDWASH:-

25. MOMENTS OF HANDWASH:-

26. 2. PERSONAL HYGIENE
• A good personal hygiene
is mandatory
• Nails
• Hair
• Beard and moustaches
3. CLOTHING
• Working clothes
• Shoes
• Caps
4. MASKS :-
• Patient protection
• Staff protection
• Prevent transmission
5. GLOVES :-
•Sterile gloves – patient
protection
•Non sterile gloves –
1.staff protection.
2. procedures like
bronchoscopy6. Safe injection practices
• Eliminate unnecessary injections
• Use sterile needle and syringe
• Use disposable needle and syringes, if
possible
• Prevent contamination of medications
• Follow safe sharps disposal practices

27. PREVENTING TRANSMISSION FROM
ENVIRONMENT:-
1. Cleaning of the hospital environment
• Routine cleaning is necessary to ensure a hospital
environment which is visibly clean, and free from dust and soil.
• Ninety per cent of microorganisms are present within “visible
dirt”, and the purpose of routine cleaning is to eliminate this
dirt.
• Cleaning agents used for walls,floors, windows, beds, curtains,
screens, fixtures, furniture, baths and toilets, and all reused
medical devices.
• Methods must be appropriate for the likelihood of
contamination, and necessary level of asepsis.

28. Cont.
• This may be achieved by classifying areas into one of four hospital zones :
1. Zone A: no patient contact. Normal domestic cleaning (e.g. administration, library).
2. Zone B: patients not infected,and not highly susceptible - use of a detergent solution
improves the quality of cleaning. Disinfect any areas with visible contamination with
blood or body fluids prior to cleaning.
3. Zone C: infected patients (isolation wards).- Clean with a detergent/disinfectant
solution,separate cleaning equipment for each room.
4. Zone D: highly-susceptible patients (protective isolation) or protected areas such as
operating suites, delivery rooms, intensive care units , premature baby units,
casualty departments and haemodialysis units. Clean using a detergent/disinfectant
solution and separate cleaning equipment.

29. 2. Use of hot/superheated water :-
1. Sanitary equipment  80 °C  45–60 seconds
2. Cooking utensils  80 °C  1 minute
3. Linen  70 °C  25 minutes
95 °C  10 minutes
3. Disinfection of patient equipment :-
A disinfectant must –
1. meet criteria for killing of organisms
2. have a detergent effect
3. act independently of the number of bacteria
present, the degree of hardness of the water, or
the presence of soap and proteins
4. easy to use
5. non-volatile
6. not harmful to equipment, staff or patients
7.free from unpleasant smells
8. effective within a relatively short time.

30. 4. STERILISATION :-
• The process by which all the living microorganism including viable
spores are either destroyed or removed from an article , body
surface or medium.
• Reduces the microbial load to 10-6
• Can be achived by
1. Physical method
2. Chemical method

31. Infection control programmes :-
1. National or regional programmes :-
The responsible health authority should develop a national programme to support
hospitals in reducing the risk of nosocomial infections. They must :-
• set relevant national objectives consistent with other national health care objectives
• develop and continually update guidelines for recommended health care surveillance,
prevention, and practice.
• develop a national system to monitor selected infections and assess the effectiveness of
interventions.
• harmonize initial and continuing training programmes for health care professionals
• facilitate access to materials and products essential for hygiene and safety
• encourage health care establishments to monitor nosocomial infections, with feedback to
the professionalsconcerned.

32. Cont..
2. Hospital programmes :-
• Risk prevention for patients and staff is a concern of everyone in the
facility, and must be supported at the level of senior administration.
• A yearly work plan to assess and promote good health care, appropriate
isolation, sterilization, and other practices.
• staff training and epidemiological surveillance should be developed.
• Hospitals must provide sufficient resources to support this programme.

33. INFECTION CONTROL COMMITTEE :-
TASKS :-
• to review and approve a yearly programme of
activity for surveillance and prevention
• to review epidemiological surveillance data and
identify areas for intervention
• to assess and promote improved practice at all
levels of the health facility
• to ensure appropriate staff training in infection
control and safety.
• to review risks associated with new technologies,
and monitor infectious risks of new devices and
products, prior to their approval for use.
• to review and provide input into investigation of
Epidemics
• to communicate and cooperate with other
committees of the hospital with common
interests such as Pharmacy and Therapeutics
or Antimicrobial
Use Committee, Biosafety or Health and Safety
Committees, and Blood Transfusion Committee.

34. Infection control professionals (infection
control team)
ROLE :-
• organizing an epidemiological surveillance programme for nosocomial infections
• participating with pharmacy in developing a programme for supervising the use of anti-
infective drugs
• ensuring patient care practices are appropriate to the level of patient risk
• checking the efficacy of the methods of disinfection and sterilization and the efficacy of
systems developed to improve hospital cleanliness
• participating in development and provision of teaching programmes for the medical,
nursing, and allied health personnel, as well as all other categories of staff
• providing expert advice, analysis, and leadership in outbreak .
• investigation and control participating in the development and operation of regional and
national infection control.

35. HICC PROFESSIONALS
1. Chair person – usually medical superintendant
2. Secretary – usually head of department of microbiology
3. Hospital infection control officer – a representative from
department of microbiology
4. Hospital infection control nurse
5. Head of all clinical departments
6. Nursing superintendant
7. Head of staff clinic
8. Ot superviser
9. Incharge of central sterile supplies department
10. Incharge of pharmacy
11. Incharge of hospital lenin
12. Incharge of hospital laundary
13. Incharge of hospital kitchen
14. Epidemiologist
15. Incharge of engineering department of the
hospital

36. DEALING WITH OUTBREAK:-
1. Identifying an outbreak – Early identification of an outbreak is important to limit transmission
among patients by health care workers or through contaminated material.
2. Investigating an outbreak – Systematic planning and implementation of an outbreak
investigation is necessary.
 Planning the investigation –
• Notify the appropriate individuals and departments in the institution of the problem; establish terms of
reference for the investigation.
• Infection control staff to be informed
• Confirm whether there is an outbreak by reviewing preliminary information on the number of potential
cases, available microbiology, severity of the problem, and demographic data of person(s), place and
time.

37. Cont..
 Case definition should be developed – it must include a unit of time and place and
specific biological and/or clinical criteria. The inclusion and exclusion criteria for cases must be
precisely identified.
Describing the outbreak – The detailed description includes person(s), place, and time.
Cases are also described by other characteristics such as gender, age, date of admission, transfer
from another unit, etc.
Suggesting and testing a hypothesis – This includes identifying a potential exposure
(type and route) for the outbreak and testing this hypothesis using statistical methods. A case-
control study is the most common approach to hypothesis testing.
Control measures and follow-up - to control the current outbreak by interrupting the
chain of transmission to prevent future occurrence of similar outbreaks.
Communication - timely uptodate information must be communicated to the hospital
administration, public health authorities, and, in some cases, to the public.
Information may be provided to the public and to the media with agreement of the
outbreak team, administration and local authorities.