HEALTHCARE ASSOCIATED INFECTION (HAI)

HEALTHCARE ASSOCIATED INFECTION (HAI)

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Also known as Nosocomial infection / /Hospital acquired infection

/ Hospital associated infectionAlso occupational infections among staff

For patients : Infections that first appear 48hrs or more after hospital admission or within 30 days after discharge.

Some Statistics for HAI: Affects ~ 10% of all in-patients Delays discharge Costs 2 x more than if there is no infectionShow increasing trend among patients and staff

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Crowded hospital conditions

New microorganism

Increasing people with compromised immune system

Increasing Bacterial resistance (MRSA, resistant Gram

negatives) HAI reducible by 10- 30%

RISE IN HAI AS A RESULT OF 4 FACTORS

HAI - EPIDEMIOLOGY

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Can be exogenous (external organism) and endogenous (opportunist normal flora)

Host susceptibility : important factor in development of HAI

MEDICAL EQUIPMENTS AND PROCEDURES (surgery) are often responsible for infections

HAI :Mode of Transmission

Contact/hand borne (most common)

Air borne Oral route

Parenteral route

Vector borne6

1.Contact (most common)

Direct (physical contact)

◦ eg when a staff turns a patient, gives patient a bath , examination of patient

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Indirect-contact Transmission

Involves contact of a host with a contaminated intermediate object ， eg:

Contaminated instruments / needles/dressings

Contaminated gloves that are not changed between patient.

Contaminated surface by needles (Jarum diletak atas permukaan selepas ambil darah ! ）》》》

Dried blood can transmit HEPATITIS B/C

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RISIKO HAI

Hep B virus can live outside d body at least 7 days

Hep C virus can live outside d body for 16h - 4 days

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2.VECTOR TRANSMISSION

Transmitted through insects eg mosquitoes and fleas. ( eg Denggi)

3.AIR BORNE TRANSMISSION

Tiny droplet nuclei that remain suspended in air.（ Eg TB)

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4.DROPLET TRANSMISSION

Droplet generated by sneezing, coughing or respiratory tract procedures eg suction

EX : Influenza,TB

AGENTS OF HA INFECTIONS

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VIRUSBACTERIA FUNGI

Hospital Procedure Pose Many Risks to HAI

Nebuliser mask CatheterizationIV Procedure Dressing BedpansUrinals Dirty couch etc.

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Predisposing Factors fOR HAIAge （ Young children ， Elderly ）Severity of IllnessMedical conditionsImmuno compromisedMalnutritionObesity

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COMMON SITES OF HAI

Patients in Labour Room / ICU

Patients undergoing invasive procedures /operation.

Areas of hospital with poor ventilation

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5 COMMON TYPES OF HAI1. Urinary Tract Infections (UTI)2. Surgical Wounds Infections (SWI)3. Pneumonia4. Skin5. Blood stream infection/ Bacteremia

Staff : URTI/ Conjunctivitis /Pertussis/TB etc

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COMMON SITES OF INFECTION

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URINARY TRACT INFECTIONS

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Most common cause of HAI

80% of UTI are associated with indwelling catheters.

SURGICAL SITE INFECTIONS

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Frequent

Definition is mainly clinical (purulent discharge around

wounds or at insertion site of drain, or spreading cellulites from wounds)

The infections can be exogenously

or endogenously

NOSOCOMIAL PNEUMONIA

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Most important are patients

on ventilators in ICU.

Recent and progressive radiological opacities of pulmonary parenchyma,

purulent sputum and recent onset

fever.

PREVENTION & CONTROL OF HAI

1. Observance of aseptic technique 2. FREQUENT HAND WASHING esp. between patients

3. Cleaning, and disinfection of linen and furniture etc)

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PPE: Wear Gloves For two reasons:

Provide a protective barrier and prevent contamination of hands

Reduce likelihood that microorganism present on

hands will be transmitted to patients during procedure.

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HAND HYGIENE TO PREVENT HAI

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You can get 100s to 1000s of bacteria on your hands by doing simple tasks like: Assisting pt up in bed / Touching pt’s gown or bed sheets

Hand Washing is Important Because… 80% of disease is spread by your hands.

Hand Hygiene : single most effective intervention to reduce the cross transmission of HAI

PREVENTION & CONTROL OF HAI

4. Sterilization of instrument eg nebulizer/oxygen mask/Use of single-use disposable items

5. Patient isolation eg Pertussis/TB etc

6. Avoidance of medical procedures that can lead to HAI ( eg. urinary catheter)

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HAI : What is most Important

Effective surveillance and action by infection control team to reduce infection rates.

Important role of team : monitor compliance and practices to prevent HAI

EXAMPLE OF HAI

TB in HCW

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HCW - TB Cases & Notification Rate, Malaysia 2003-2014

Control & Prevention Measures of TB among HCWs

Risk for TB among HCWs is consistently higher than general population worldwide (Joshi, 2006) 29

ii. ADMINISTRATIVE CONTROL• Periodic TB Screening for HCWs

Control & Prevention Measures of TB among HCWs

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iii. PPE• N95 (respirator) must be used in high

risk TB areas TB ward, chest clinic Isolation room Procedure room eg. sputum induction room

• HCW to use N95• Patient to use Surgical Mask

Control & Prevention Measures of TB among HCWs

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Control & Prevention Measures of TB among HCWs

ConclusionIn addition to having TB guidelines with environmental / engineering; administrative; and respiratory-protection controls; HCWs must change their behaviour towards healthy and safer work culture in order to prevent & control TB at the workplace.

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Thank YouThank You33