Hospital acquired infections

the matter is taken from net

1. HOSPITAL ACQUIRED INFECTIONS Aarti Sareen MSPT Honours I Roll No. 8

2. H ospital acquired infection is also called Nosocomial infection or H ealthcare-associated infections . " nosus " = disease " komeion " = to take care of Nosocomial infections can be defined as infection acquired by the person in the hospital, manifestation of which may occur during hospitalization or after discharge from hospital. The person may be a patient, members of the hospital staff and/ or visitors.

3. EPIDEMIOLOGICAL INTERACTION HOST FACTORS S uppresed immune system due to Age , Poor nutritional status, severity of underlying disease, complicated diagnostic & therapeutic procedure,therapeutic , THE AGENT Varieties of organisms Institutional and human Reservoirs & their virulence THE ENVIRNOMNET Everything that surrounds the patient in the hospital is his environment. Other patients Hospital staff and visitors Eatables Dust and other contaminated articles NCI

4. Endogenous/direct : Caused by the organisms that are present as part of normal flora of the patient Exogenous /indirect Caused by organisms acquiring by exposure to hospital personnel, medical devices or hospital environment, cross-infection from medical personnel hospital environment- inanimate objects air dust IV fluids & catheters washbowls bedpans endoscopes ventilators & respiratory equipment water, disinfectants etc Source of infection

5. EXOGENOUS INFECTION SITES

6. The Inanimate Environment Can Facilitate Transmission ~ Contaminated surfaces increase cross-transmission ~

7. Exogenours Pathogens

8. Mid-1980’s Enterobacteriaceae S. aureus P. aeruginosa Mid-1990’s Decline in Enterobacteriaceae Increase in gram-positive cocci Emergence of fungi Recognition of viruses Nosocomial Infections: Changing Microbiology

9. Viruses Bacteria Fungi Parasites All microorganisms can cause nosocomial infections

10. Gram + ve Staphylococcus aureus Staphylococcus epidermidis Gram - ve Enterobacteriaceae Pseudomonas aeruginosa Acinetobacter baumanni Mycobacterium tuberculosis BACTERIA

11. COMMON BACTERIAL AGENTS (9%) (10%) (11%) (12%) (13%) (45%)

12. Viruses Blood borne infections : HBV, HCV, HIV Others: rubella, varicella , SARS Fungi Candida Aspergillus

13. Urinary tract infections (UTI) Surgical wound infections (SWI) Lower respiratory infections Traumatic wounds and burns infections Primary bacteraemia Gastrointestinal tract Central nervous system TYPES OF INFECTIONS

14. Major Types of Nosocomial Infections Richards, MJ. 1999. Crit Care Med 27; 887.

15. Mode of trasmission Contact/hand borne (most common) Aerial route or air borne Oral route Parenteral route Vector borne

16. Direct (physical contact) Hands & clothing Droplet contact followed by autoinoculation Clinical equipment Indirect via contaminated articles Bedpans, bowls , jugs, Instruments like needles, dressings, contaminated gloves,etc . Contact (most common)

17. Airborne Transmission Droplet respiratory secretions on surfaces Inhalation of infectious particles e.g. (TB, Varicella ) Oral route Parenteral route Vector borne: through mosquitoes, flies, rats

18. Pathogens transmission

19. The hands are the most important vehicle of transmission of HCAI

20. Why Don’t Staff Wash their Hands (Compliance estimated at less than 50%)

21. Why Not? Skin irritation Inaccessible hand washing facilities Wearing gloves Too busy Lack of appropriate staff Being a physician (“Improving Compliance with Hand Hygiene in Hospitals” Didier Pittet . Infection Control and Hospital Epidemiology. Vol. 21 No. 6 Page 381)

22. Hand Hygiene Techniques Alcohol hand rub Routine hand wash 10-15 seconds Aseptic procedures 1 minute Surgical wash 3-5 minutes

23. Repeat procedures until hands are clean Routine Hand Wash

24. Areas Most Frequently Missed HAHS © 1999

25. Hand Care Nails Rings Hand creams Cuts & abrasions “Chapping” Skin Problems

26. Hand hygiene is the simplest, most effective measure for preventing hospital-acquired infections.

27. S urveillance

28. Why surveillance? NCI cause of morbidity and mortality One third may be preventable Surveillance = key factor an infection control measure overview of the burden and distribution of NCI allocate preventive resources Surveillance is cost-efficient!!

29. Objectives Reducing infection rates Establishing endemic baseline rates Identifying outbreaks Identifying risk factors Persuading medical personnel Evaluate control measures Satisfying regulators Document quality of care Compare hospitals’ NCI rates

30. The surveillance loop Event Action Data Information Health care system Surveillance centre Reporting Feedback, recommendations Analysis, interpretation

31. Considerations when creating a surveillance system Goal of the surveillance system (why) Engage the stakeholders (who) Surveillance method (what, how, when) definition what to collect how to collect (operation of system) Available resources

32. Who All hospitals? All departments? All specialties? Other health institutions?

33. Stakeholders

34. Control of NCI

35. There are three principal goals for hospital infection control and prevention programs: Protect the patients Protect the health care workers, visitors, and others in the healthcare environment. Accomplish the previous two goals in a cost effective and cost efficient manner, whenever possible. . Goals for infection control and hospital epidemiology

36. To control the nosocomia l infection w e need to consider the chain of infection and the transmission of an infectious agent

37. observance of aseptic technique frequent hand washing especially between patients careful handling, cleaning, and disinfection of fomites where possible use of single-use disposable items patient isolation avoidance where possible of medical procedures that can lead with high probability to nosocomial infection (urinary catheter) Prevention & control of nosocomial infections

38. Various institutional methods such as air filtration within the hospital Appropriate isolation precautions to protect patients, visitors, and HCWs. Surveillance for common infections, monitoring of high risk patients, and hospital area to identify outbreaks, document incidence and prevalence rate of specific infections and set goal for improvement. Prevention & control of nosocomial infections (cont.)

39. Uttermost care should be taken in following services: House keeping Dietary services Linen and laundry Central sterile supply department Nursing care Waste disposal Antibiotic policy Hygiene and sanitation

40. The 5 pillars of infection control Isolation & barrier precautions Decontamination of equipment Prudent use of antibiotics Hand washing Decontamination of environment

41. Infection Control Committee

42. Infection control Committee (ICC): The hospital ICC is charged with the responsibility for the planning, evaluation of evidenced-based practice and implementation, prioritization and resource allocation of all matters relating to infection control.

43. Infection Control Team Infection Control Nurse (ICN) I nfection C ontrol Doctor (ICD)

44. Role of infection control teams Education and training Development and dissemination of infection control policy Monitoring and audit of hygiene Clinical audit