hospital acquired infection unit 1.pptx

hAI and role of nurses

1. HOSPITAL ACQUIRED INFECTION

2. INTRODUCTION Healthcare associated infections are one of the most common adverse events in the care delivery system. According to WHO on average at any given time 7% of patients in developed and 10% in developing countries acquire at least one HAI. Mortality from HAI occurs in about 10% of affected patients.

3. DEFINITION Healthcare associated infections can be defined as Infections acquired in the hospital by a patient admitted for a reason other than the infection in contex Infection should not be present or incubating at the time of admission The symptoms should appear at least after 48 hours of admission

4. This also includes : Infections that are acquired in the hospital but symptoms appear after discharge Occupational infections among staff of the health care facility. Infection in neonate that results while passage through the birth canal

5. FACTORS AFFECTING HAI IMMUNE STATUS

6. HOSPITAL ENVIRONMENT

7. HOSPITAL ORGANISMS

8. DIAGNOSTIC AND THERAPEUTIC INTERVENTIONS

9. TRANSFUSION

10. POOR HOSPITAL ADMINISTRATION

11. SOURCE OF INFECTION Endogenous source The majority of HAI are endogenous in origin which involve patient’s own flora which may invade the patient’s body during some surgical or instrumental manipulations

12. Exogenous source It is from the hospital environment, health care workers or patients

13. MICRO ORGANISMS IMPLICATED IN HAI HAIs can be caused by almost any micro organisms but those which survive in the hospital environment for long periods and develop resistance to anti microbial and disinfectants are particularly important

14. ESKAPE PATHOGENS Enterococcus faecium Staphylococcus aureus Klebsiella pneumoniae Acinetobacter baumannii Pseudomonas aeruginosa Enterobacter species

15. Other pathogens include: Escherichia coli SARS-COV-2 M.Tuberculi Legionella pneumophilia Candida albicans Clostridioides difficile diarrhoea HIV ,Hep B, Hep C

16. MODE OF TRANSMISSION Mode of transmission include Contact Droplet Airborne transmission

17. MAJOR HAI TYPES Catheter associated urinary tract infections Central line associated blood stream infections Ventilator associated pneumonia Surgical site infection

18. CARE BUNDLE

19. PREVENTION OF UTI ( CAUTI) Insertion bundle Catheter should be inserted only when appropriate indication is present Only the sterile items are used for insertion of catheter Catheter is inserted by non touch technique with strict asepsis Catheter of appropriate size must be used Catheter must be properly secured after placement

20. Maintenance bundle Daily catheter care must be given regularly and by strict aseptic measures such as hand hygiene and single use gloves Catheter is properly secured all the times Drainage bag must be always above the floor and below bladder level Closed drainage system is used all the time

21. Contd While collection of urine from bag, the following steps must be followed: hand hygiene, change of gloves between patients, use of separate jug for each bag , use of alcohol swab for disinfecting of outlet Daily assessment of readiness for removal of catheter must be documented.

22. CARE BUNDLE FOR CENTRAL LINE ASSOCIATED BLOOD STREAM INFECTION (CLABSI )

23. Insertion bundle Hand hygiene before and after insertion of central line Use maximum sterile PPE Site of insertion – subclavian preferred and femoral is avoided Skin preparation- by antiseptics such as chlorhexidine

24. Skin must be completely dry after use of antiseptics Use semi permeable dressing Document date and time of insertion

25. Maintenance bundle Daily aseptic central line care during handling Daily documentation of local signs of infections Daily assessment of readiness for removal of central line must be documented

26. Maintenance care bundle for VENTILATOR ASSOCIATED PNEUMONIA ( VAP) Adherence to hand hygiene Elevation of the head of the bed to 30-45 degree Daily oral care with chlorhexidine solution 2% solution Need of PUD( peptic ulcer disease) prophylaxis should be assessed daily DVT prophylaxis Daily assessment with readiness to remove mechanical ventilator must be documented

27. PREVENTION FOR SURGICAL SITE INFECTION Preoperative measures Pre operative bathing: it should be performed using plain soap or an anti microbial soap to reduce the bacterial load, especially at the site of incision For MRSA Carriers: decolonization with muciprocin ointment must be done for patients undergoing surgery who are nasal carriers of MRSA Hair removal: for patients undergoing any surgical procedure hair removal should not be done or if absolutely necessary it should be removed with clipper.

28. Intra operative measures: Surgical anti biotic prophylaxis must be provided for all times except clean surgeries Surgical hand disinfection Surgical site preparation Perioperative maintenance of oxygen ( target Fi02 80%) and normothermia, blood glucose level ( < 200 mg/dl), normovolemia and nutritional support are necessary

29. Post operative measures Wound dressing OT disinfection Periodic monitoring of the air quality of operation theatre SAP prolongation is not recommended

30. SURVEILLANCE OF HAI

31. Health care associated infections surveillance is a system that monitors the HAIs in a hospital. The main objectives of HAI surveillance include: Provides endemic or baseline HAI rate and information on the type of HAIs in the hospital Helps in comparing HAI rates within and between hospitals Identifies the problem areas Provides timely feedback to the clinicians

32. TARGETTED SURVEILLANCE The national healthcare safety network division of CDC provides guidelines for the surveillance of HAIs Where to conduct What type of HAIs to be monitored Who will conduct HAI surveillance diagnostic criteria

33. METHOD OF COLLECTING HAI SURVEILLANCE Data collection Data analysis Data interpretation Data dissemination

34. HOSPITAL INFECTION CONTROL COMMITTEE It is run by the medical superintendent who he/she constitutes the hospital infection control committee.

35. FUNCTIONS OF HICC HAI surveillance Develops a system Antimicrobial stewardship program Policies Education Staff health Outbreak management Other departments co ordination Reviews HICC meetings

36. RESPONSIBILITY OF DIFFERENT STAKEHOLDERS OF HICC Hospital administration Establish a multidisciplinary HICC Provide adequate resources Ensure availability of hand hygiene Approve and review policies and guidelines for infection control practices

37. Infection control officer The ICO is either a clinical microbiologist or an infectious disease physician Duties Meticulous planning and implementation of infection control measures Supervises the HAI surveillance activities Plays an active role in investigation of the outbreak

38. Conducts research related activities Supervises the activities of department of biomedical waste Acts as nodal officer for management of needle stick injury Ensure implementation of safe work practices Ensures immunization of all HCWs as recommended

39. Formulate and implement guidelines for sterilization of equipments and instruments Involves in drawing up annual plans Prepares annual budget of HICC Conducts regular surveys and surprise visits Performs AMR surveillance and disseminates annual hospital location/department specific antibiogram

40. Actively participates in implementing anti microbial stewardship program and also co ordinates formulation of anti biotic policy Review and revision of infection control manual.

41. INFECTION CONTROL NURSE An ICN is a registered nurse with an additional academic education and practical training in infection control, clinical and diagnostic microbiology, epidemiology and computer technology

42. DUTIES OF ICN Carry out data collection of HAI surveillance, hand hygiene audit, care bundle audit. PPE audit etc by performing daily visits to ICUs and wards Oversee the implementation of transmission based precautions whenever necessary Monitors the implementation of disinfection policy at the hospital

43. Identifies the high risk areas for conducting environmental surveillance Involves in education of healthcare workers and patients Provides post exposure prophylaxis for needle stick injury cases. They also maintain registers and data on needle stick injuries In a certain healthcare facility, ICNs are also involved in conducting antimicrobial stewardship activities

44. INFECTION CONTROL LINKS NURSE If adequate ICNs are not available, then the existing nursing staff working in ICUs can be trained so that they can be part time engaged in monitoring infection control activities of their concerned ICUs

45. Some studies have shown that A competent infection control links nurse can motivate ward staff by enabling more effective practice This practice can be very much useful, provided the link nurses are adequately trained and backed up by strong infection control team Lack of adequate training, frequent turnover of nurses, lack of recognition of their role are the problem areas that need to be addressed while implementing this program.