NOSOCOMIAL INFECTIONS.pptx

NOSOCOMIAL INFECTION OR HOSPITAL ACQUIRED INFECTION
OR HEALTHCARE ASSOCIATED INTECTION CAN BE DEFINED AS THE INFECTION ACQUIRED IN THE HOSPITAL BY A PATIENT:
WHO WAS ADMITTED FOR A REASON OTHER THAT INFECTION
FACTORS AFFECTING HAIS
SOURCES OF INFECTION
MICRORGANISMS RESPONSIBLE FOR INFECTION
TYPES OF HAIS
MODE OF TRANSMISSION
PREVENTION OF HAIS

1. INSHA JAN NOSOCOMIAL INFECTIONS 1

2. Definition Hospital acquired infections or nosocomial infections or healthcare-associated infections ( HAis ) can be defined as the infections 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 at least after 48 hours after admission This include infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the hospital care facility HOSPITAL ACQUIRED INFECTIONS (HAis) 2

3. The principal factors that determine the likelihood that a given patient would acquire a nosocomial infection are: Immune status : Most admitted patients have impaired immunity either as a part of their preexisting disease processes or, in some instances, due to the treatment they have received in the hospital. Hospital environment : the hospital environment harbors a greater magnitude of microorganisms than that of community. Transmission of these organisms to the patients can cause nosocomial outbreaks of infection. Factors Affecting HAIs 3

4. Hospital organisms: Most of the organisms present in the hospital environment are multidrug resistant. this is because of t he increased antibiotic usage in the hospital . the minor population of resistant organisms present initially flourish in presence of constant antibiotic pressure and slowly replace the susceptible strains in die hospital. Factors Affecting HAIs 4

5. Diagnostic or therapeutic interventions such as insertion of intravenous or urinary catheters, or endotracheal tube, may introduce infection in susceptible patients ; most of which are due to the patient's endogenous flora Transfusion: Blood, blood products and intravenous fluids used for transfusion, if not properly screened, can transmit many blood borne infections ( BBI) such as HIV , Hepatitis B and C viruses. Poor hospital administration : Strong administrative support is essential to control the Hals; failing of which promote the spread of HAls . Factors Affecting HAIs 5

6. Endogenous Source The majority of nosocomial infections are endogenous in origin, i.e. they involve patient's own microbial flora which may invade the patient's body during some surgical or instrumental manipulations. Exogenous Source Exogenous sources are from hospital environment, staff, or patients. Sources of Infection 6

7. Environmental sources include inanimate objects, air, water and food in the hospital. Inanimate objects in the hospital are medical equipment's (endoscopes, catheters , etc.), bed pans, surfaces contaminated by patients' excretions, blood and body fluid. Healthcare workers may be potential carriers, harboring many organisms; which may be multidrug resistant, e.g. nasal carriers of Methicillin-resistant Staphylococcus aureus (MRSA). Other patients of the hospital may also be the source of infection Source of infection 7

8. Hospital acquired infections can be caused by almost any microorganism, but those that survive in the hospital environment for long periods and develop resistance to antimicrobials and disinfectants are particularly important . The ESKAPE pathogens: They are responsible for a substantial percentage of nosocomial infections in the modern era and represent the vast majority of multidrug resistant isolates present in a hospital. Enterococcus faecium Staphylococcus aureus Klebsiella pneumoniae Acinetobacter baumannii Pseudomonas aeruginosa Enterobacter species Microorganisms implicated in HAis 8

9. Other infections that can spread in hospitals include: Escherichia coli Nosocomially acquired Mycobacterium tuberculosis Legionella pneumophila Candida albicans Clostridium difficile diarrhea Microorganisms implicated in HAis 9

10. Microorganisms spread in the hospital through several modes Contact transmission Direct contact : Skin to skin contact and thereby physical transfer of microorganisms between a susceptible host and an infected or colonized person (usually healthcare workers, rarely other patients ) Indirect contact : this involves contact of a susceptible host with contaminated inanimate objects such as: Dressings, or gloves, instruments (e.g. stethoscope) Parenteral transmission through: Needle or sharp prick Injury, splashes of blood or body fluids or excretions, contaminated saline flush, . syringes , vials and bags Modes of Transmission 10

11. Inhalation mode Droplet transmission: Droplets of >5 µm size can travel for shorter distance (< 3 feet) Droplets generated from the infected person while coughing. sneezing and talking are propelled for a short distance through the air and deposited on the host's body. This is an important mode of transmission of agents causing bacterial meningitis, diphtheria, and RSV etc Modes of Transmission 11

12. Inhalation mode Airborne transmission: This refers to the airborne droplet nuclei ( 5 µm size) or dust particles that remain suspended in the air for long time and can travel longer distance This is more efficient mode than droplet transmission. Microorganisms transmitted by airborne transmission include Legionella , Mycobacterium tuberculosis , measles and varicella-zoste r viruses . Modes of Transmission 12

13. Vector borne transmission: Via 'Vectors such as mosquitoes, flies, etc carrying the microorganisms. This is a rare mode of transmission In hospital . Common vehicle transmission: such as food, water, devices and equipment's Modes of Transmission 13

14. In any hospital the four most common HAIs encountered are : Urinary tract infections ( UTIs ) (33%) Pneumonia (15%) Surgical site infections (15%) Blood stream infections ( 13%) Types of HAIs 14

15. Urinary tract infections account for the majority of HAis. Risk factors that predispose patients to acquire a nosocomial UTI include- Advanced age, Female gender, Severe underlying disease , Placement of a urinary catheter . Organisms : Gram-negative rods cause the majority of hospital acquired UTIs and E. coli is the number one organism implicated. Gram-positive bacteria and Candida cause the remainder of the infections. Urinary Tract Infections ( UTIs ) 15

16. lung infections are the major cause of HAIs after UTI. Risk factors to develop nosocomial pneumonia are advanced age, chronic lung disease, aspiration of upper respiratory tract secretions into the lungs , semiconscious patient, chest surgeries mechanical ventilation through intubation of endotracheal tube ( ventilator-associated pneumonia) Organisms : Gram-negative rods and S. aureus, account for majority of infections of the patients from the hospital Pneumonia 16

17. Surgical site infections (SSI) are defined as infections that develop at the surgical site within 30 days of the surgery. Organisms: Surgical site wounds are classified as clean, clean-contaminated, contaminated or dirty. For clean wound: The skin flora of the surgery team or the environmental organisms are the major pathogens; most common being S. aureus. For other types: The patients endogenous flora (anaerobes and gram-negative rods) are the common agents. Surgical Site Infections 17

18. Risk factors for nosocomial wound infection include: Advanced age, O besity , Malnutrition, Diabetes , Infections at a remote site that spread through blood stream Time interval between pre-operative shaving of the site and the surgery-if exceeds more than 12 hours. Surgical Site Infections 18

19. Nosocomial blood stream infections are the fourth common cause of HAIs . Organisms: Coagulase negative staphylococci , S. aureus and enterococci are increasingly reported recently followed by gram- negative rods and Candida . Risk factors that predispose the patients to acquire a nosocomial bloodstream infection include : Age ( <1 years and >60 years), and malnutrition Low immunity or severe underlying disease loss of skin integrity (burn or bed sore ) Prolonged hospital stay, especially in ICUs Presence of intravascular catheters Blood Stream Infections 19

20. Standard (Routine) Precautions Standard precautions are a set of infection control practices used to prevent transmission of diseases that can be acquired by contact with blood, body fluids, non-intact skin (including rashes ), and mucous membranes . These measures should be followed when providing care to : All individuals, whether or not they appear infectious/ symptomatic or not. All specimens (blood or body fluids) whether they appear infectious or not. All needles and sharps whether they appear infectious or not. PREVENTION OF HAis 20

21. Components of standard precautions include: Hand hygiene: Wash hands promptly after contact with infective material Use no touch technique wherever possible Personal protective equipment's (PPEs): Wear gloves when expecting contact with blood, body fluids, secretions, excretions, mucous membranes and contaminated items and wash hands immediately after removing gloves. Sharp handling : AII sharps should be handled with extreme care Spillage cleaning : Clean up spills of infective material promptly Waste handling : Ensure appropriate biomedical waste seggregation and disposal 21

22. Specific precautions Additional precautions are needed for preventing specific m odes of transmission. Airborne Precautions the following measures are required: Individual room should be provided with adequate ventilation with negative pressure facility. Staff should wear high-efficiency m asks in room Patient should be confined to the room. PREVENTION OF HAis 22

23. Droplet Precautions The following procedures are required: Individual room for the patient, if available Mask for healthcare workers Restricted movement of the patient; patient wears a surgical mask while leaving the room. PREVENTION OF HAis 23

24. Contact Precautions T hese are required for patients with enteric infections and diarrhea which cannot be controlled , or skin lesions which can not be contained. Individual room for t he patient if available; cohorting of patients if possible Staff should wear gloves and gowns on entering the room. Hand washing should be done before and after contact with the patient, and on leaving the room. Appropriate environmental and equipment cleaning, disinfection, and sterilization to be followed. PREVENTION OF HAis 24

25. Precautions for Patients with MDROs The increased occurrence of multidrug resistant organisms (MDROs) is a major medical concern. the spread of MDROs such as multidrug resistant MRSA is usually by transient carriage on the hands of healthcare workers. The following precautions are required for the prevention of spread of epidemic of MRSA: Minimize ward transfers of staff and patients Ensure early detection of cases, especially if admitted from another hospital; screening of high risk patients may be considered PREVENTION OF HAis 25

26. Precautions for Patients with MDROs Isolate infected or colonized patients in a single room, isolation unit or cohorting in a larger ward Reinforce hand washing by staff after contact with infected or colonized patients Use gloves, gown or apron for handling MRSA contaminated m aterials , or infected or colonized patients Consider treating nasal carriers with mupirocin Consider daily wash or bath by antiseptic detergents for carriers or infected patients. Ensure careful h andling and disposal of medical devices., linen, waste, etc. Develop guidelines specifying when isolation measures can be discontinued. PREVENTION OF HAis 26

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