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Dr Narender Saini
M.D.Chairman Hospital Infection
Control Committee
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HAI
Hospital Acquired infections are
infections if they first appear 48 hours or
more after hospital admission or within
30 days after discharge and extended
upto 12 month incase of implanted
device.
This type of infection is also known as
Healthcare-Associated Infection
Nosocomial- Greek word
nosokomeion
meaning hospital
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Incidence Of HAI
Developed countries: 6-10%
India: Around 20%
Socio-economic burden of HAI
delays discharge
HAI costs 2 times
direct cause deaths
Medico Legal issues
Reputation of the Hospital
Nearly 1/3rd are preventable
by effective hospital infection
control program
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HAI
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HAI is Increasing
y Compromised patients
y Ward and inter-hospital transfers
y Antibiotic resistance (MRSA, Resistant Gram
Negatives)
y Increasing workload
y Staff pressures
y Lack of facilities
y
Lack of concerny HAI is inevitable but some is preventable
y Realistically reducible by 30%
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Weakened immune systems
Some medical procedures bypass the body's natural protectivebarriers.
The staff themselves serve as a means for spreading pathogen.
Irrational use of antibiotic.
Hospital Environmental Factors
Causes Of HAI
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Patients own flora : Endogenous
Auto Infection (50%)
Sources of Infection
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Sources of Infection
Other People /Other People / Patient / Staff - Cross Infection (35%)
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Sources of Infection
Healthcare workers can get 100s to 1000s of bacteria on their hands
by doing simple tasks like:
pulling patients up in bed
taking a blood pressure or pulse
touching a patients hand
rolling patients over in bed
touching the patients gown or bed sheets
touching equipment like bedside rails, over bed tables, IV pumps
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Why Dont Staff Wash their Hands?
(Compliance estimated at less than 50%)
Sources of Infection
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Sources of Infection
Hand Wash, Why Not?
Skin irritation
Inaccessible hand washing facilities
Wearing gloves
Too busy Lack of appropriate staff
Being a physician
Lack of hand hygiene promotion
Lack of role model Lack of institutional priority
Lack of sanction for non-compliers
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Sources of Infection
Environmental (15%)
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Sources of Infection
Vectors
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Sources of Infection
Animals
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Sources of Infection
Fomites / Instrument (10%)
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Sources of Infection
Food-Stuffs
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Sources of Infection
Blood Contact
Direct inoculation of infective organism into bloodstream
Needle-stick injuries
Hepatitis B and C
HIV
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Sources of Infection
Vertical Transmission Transmission from mother to child in utero or during delivery
HIV, CMV
Breast-feeding can also result in transmission of infection from
mother to child
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Etiological Agents
Common HAI :
Bloodstream infections - 28%
Ventilator-associated pneumonia - 21%
Urinary tract infection (UTI) - 15%
Lower respiratory infection - 12%
Gastrointestinal, skin, soft tissue, and cardiovascular infections -10%
Surgical-site infections - 7%
Ear, nose and throat infections - 7%
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Etiological Agents
Etiologies in bloodstream infections
Coagulase-negative staphylococci - 40%
Enterococci - 11.2%
Staphylococcus aureus - 9.3%
Enterobacter species - 6.2%
Pseudomonas - 4.9%
Acinetobacter
Fungi - 9.65%
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Etiological Agents
Nosocomial etiologies in UTI
Gram-negative bacilli- 50%
Fungi - 25%
Enterococci - 10%
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Etiological Agents
Nosocomial etiologies in surgical-site infections
S aureus - 20%
Pseudomonas - 16%
Coagulase-negative staphylococci - 15%
Enterococci, fungi, Enterobacter species, and Escherichia coli
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Etiological Agents
Nosocomial etiologies in fever
Viral infections are most common causes of nosocomial fevers.
Phlebitis is the second most common cause of nosocomialfevers in the hospitalized child.
Clostridium difficile colitis is also a cause of nonsocomial fevers.
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Transmission
Micro-organism transmitted by several routes.
Five main routes.
Contact, Droplet, Airborne, Common vehicle and Vectorborne.
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Control of HAI
Based on knowledge of :
Source of infection
How infection is acquired
How infection is spread
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Control of HAI
GENERAL PRINCIPLES
Good general ward hygiene:
- No overcrowding- Good ventilation
- Regular removal of dust
- Wound dressing early in day
- Disposable equipment
HAND WASHING - Most Important
- Before and after patient contact
- Before invasive procedures
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Examples of Control of
Infection
Handwashing and protective clothing
Thank you for helping us to protect your family and friendsThank you for helping us to protect your family and friends
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Examples of Control of
Infection
Hand hygiene is the
simplest, most effectivemeasure for preventinghospital-acquiredinfections.
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Examples of Control of
Infection
Routine Hand Wash
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Examples of Control of
Infection
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Examples of Control of
Infection
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Examples of Control of
Infection
Hospital Design
Proper Ventilation
Isolation Rooms
Sanitation
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Preventing Cross
Infection
If known or suspected on admission to hospital, or detected
following admission:
- Isolation (barrier precautions)
- Inform Infection Control team
- Treatment - if appropriate
- Regular surveillance
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Surveillance
Early detection of trends outbreaks :
1. Laboratory BasedMicrobiology Laboratory lists +ve organismsICN reviews Alert organisms reported
2. Ward BasedWard staff monitor patientsICN reviews
ICN visits wards- Environmental swabs
3. Water
4. Kitchen
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Recommendations
I. Administrative Control
Education : Develop a system educate
patient and visitors.
Adherence to precautions : periodically
evaluate adherence to precautions use
findings to direct improvement.
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Respiratory Protection
-Wear respiratory protection patient with known or suspected
infectious.
Patient Transport
-Limit the movement and transport of the patient.
-If movement/transport is necessary mask the patient .
e.g. Tuberculosis, measles and chickenpox.
Airborne Precautions
Recommendations
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Patient Placement
Private room.
If cohorting then 3 feet distance between patients.
Special air handling.
Door may remain open.
Droplet Precautions
Recommendations
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Mask
Wear a mask when working within 3 feet of the patient.
Patient Transport
As described in airborne precaution.
E.g. meningitis, influenza, mumps, rubella.
Droplet Precautions
Recommendations
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Contact Precautions
Use in addition to standard precautions.
Patients infected/colonised epidemiologically important micro-organism -
transmitted by direct/indirect contact.
a). Patient placement-private room\cohorting
b). Gloves, Gown and Handwashing.
c). Patient transport limit the movement -precautions minimize risk of
transmission of micro-organism.
e). Patient care equipment adequate cleaning and disinfection\sterilization.
e.g. ATB-resistant bact, Hepatitis A.
Recommendations
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HAI Control Program
Training of staff
Investigation of out break
Controlling the out break by rectification of technical
lapsis Monitoring of staff health to prevent staff to patient and
patient to staff spread of infection
Advice on procedures and infection control measure
Inspection of waste disposal, laundry and kitchen Monitoring and advice on safe use of antibiotic
Monitoring of HAI and Infection control audit
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Conclusion
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Hospital Infection Control
Committee Chairperson : HOD Consultant - Microbiologist Dr Narendra Saini
Co- Chairperson : Manager Medical Services, Quality and Accreditation MsMandakini
C
onvener : Infection Control Nurse Ms. Sunita Ninan
Members : CMD/ED Dr Vinay/Vijay Aggarwal
Dir. Med. Services Dr Naveen Jain Advisor -Dr Manju Mani
Anesthesia depart Dr Swaraj Garg GM M/E -Mr Sanjeev
Sharma
ER / Critical Care - Dr Amit Gupta Physician Dr Prakash Gera
Neurosurgeon Dr.Rajkumar CNO Ms Nomita Sarkar
GM HS & Trg Mr Mitul Patel
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Any Questions???
Thank you !!!