74587694 Hospital Infection Control 2008

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Philippine Hospital Infection Control Society (PHICS), Inc.

HOSPITAL INFECTION

CONTROL

Cecilia S. Montalban, MD, MScCTM


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INFECTION

the state or condition in which thebody or part of the body is invadedby a pathogenic agent (bacteria,

virus, parasites etc.) which underfavorable conditions multiplies andproduces injurious effects
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NOSOCOMIAL INFECTION

latin word nosocomium meaning hspital

synonymous to hospital-acquired infection

infection acquired 48 hours afteradmission to hospital (not present orincubating at the time of admission)

acquired while in the hospital and

developed after discharge


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Common Sites of

Nosocomial Infections

Urinary tract

Respiratory tract

GastrointestinalBlood stream

Skin, Wound, Burn

Surgical wound infectionOthers


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Factors Promoting

Nosocomial Infection

ageduration of hospitalizationsurgery (type of operation)

immune status: chemotherapy, radiationtherapy, malignancydiagnostic technique/ proceduresenvironment

personnelpatient
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The C ST of


PERSONNEL

Need for hospitalization

Income loss Pain and suffering

Disfigurement/Disability

Death
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The C ST of


INSTITUTIONS

Loss of revenue

Extra duty Liability insurance

Malpractice

Reputation


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BSI Pneumonia UTI

Extra daysconfinement

15 11 13

Added cost US$2,619

US$ 2,051 US$ 1,970

EXTRA C STS BY TYPE

OF INFECTION

Rosenthal and Migone. Nosocomial Infections Costs And Extra Days In

Intensive Care Units In Argentina. Prospective Cohort Matched Cases.

IV Infections Control And Hospital Epidemiology

Pan American Congress. 2002, Cancun, Mexico.


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How do infections occur in hospitalsetting ?AGENT

SUSCEPTIBLEHOST

MEANS OFTRANSMISSION
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AGENT

How do infections occur in hospitalsetting ?


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AGENTS

GRAM NEGATIVERODS

GRAM POSITIVECOCCI

OTHERS

Escherichia coli Staphylococcus

aureus

Fungi -

Candida sp.;

Aspergillus sp.

Klebsiella sp. Staphylococcus

epidermidis

Protozoans

Pseudomonas

aeruginosa

Enterococci Mycobacterium

tuberculosis

Acinetobacter sp. Pneumocystis

carinii

Enterobacter sp. Anaerobes


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Sources of Agents of

Nosocomial Infections

EXOGENOUS

Hands

Instruments

Catheters Respiratory

equipments

Transfusions

IV system

Linen

Air

ENDOGENOUS

Oropharynx

Respiratory

Gastrointestinal

Skin
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Factors Promoting EndogenousInfections

Operations

Catheters

Foreign bodies

Chemotherapy

Immunosuppression Pre-existing disease
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AGENT




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Means of Transmission ofNosocomial Infections

Contact - direct or indirect

Airborne - measles, varicella, TBDroplet - meningococcemia

Vector - insects or animals

Vehicle - food, water, blood,medication
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MEANS OF TRANSMISSIONOF NOSOCOMIALINFECTIONSCONTACTA. Direct Contact

- occurs when one persontouches another

- direct contact is an ongoing

process in the hospital- best vehicle : Hands


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MEANS OF TRANSMISSIONOF NOSOCOMIALINFECTIONSCONTACTB. Indirect Contact

- occurs when a person touches

an inanimate object

contaminated by an infected

patient


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AGENT

SUSCEPTIBLEHOST




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Factors that Increase HostSusceptibility to NosocomialInfections Chronic underlying diseases

Immune deficiency states Malignancies

Therapeutic measures Immunosuppression

Antibiotic therapy

Invasive devices

Surgery Age
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AGENT Means ofTransmission SusceptibleHostBacteria

Virus

Fungi

CONTACT

AIRBORNE

DROPLETVEHICLE

VECTOR

Disease


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BASIC PRINCIPLES ININFECTION CONTROL


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AGENT

Susceptible

HOST

Means of

Transmission

Breaking theChain of Infection
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The hands should be washed afterhandling infectious materials (e.g. bedlinen, dressings, secretion andexcretions).

The skin of the patient should bedisinfected before invasive procedures

Emphasize HANDWASHING for personal

hygiene

Basic Principles in InfectionControl


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Basic Principles in InfectionControlRational Use of Devices- Avoiding or removing factors that

impair host defenses.

- Invasive devices should be avoidedor should be removed as soon aspossible


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The environment should beHOSTILE to the multiplication ofpathogens, i.e. clean, dry, exposed

to light and well ventilated. All infectious materials (e.g. linen,

clinical waste, sharps) should be

safely contained, decontaminated ordestroyed.



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All instruments and equipment should beclean and dry. Invasive items should besterilized and items in contact with mucousmembranes, body fluids and potentially

infectious materials should be disinfected. Food should be hygienically

prepared, properly cooked and

stored at low temperatures untilused.



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Susceptible

HOST

Means of

Transmission

Hand Hygiene

Environmental Care

Waste management

Disinfection and Sterilization

Hand Hygiene

Rational use of Devices

Isolation

Immunization,

Immunotherapy

Prophylaxis

Breaking theChain of Infection

Hand HygieneAseptic Technique

practice

Environmental Care

Disinfection and

Sterilization

AGENT


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The Health Care Worker (HCW) shouldbe aware of how infection istransmitted and the factors involved in

the process The HCW should be able to implement

the MOST effective and applicable

measures to prevent and controlinfection in his place of work

The HCW should have the properattitude of infection control


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Hospita l Infect ion Con trol Comm ittee

Organizational Structure Under the office of the Medical Director

Infection Control Team

Chairperson

Infection Control Physician

Infection Control Nurse

Reps from different clinical departments

Auxiliary members from Employee Health Service,Engineering, Pharmacy, Central Sterilization and

Supply Department and Housekeeping Department
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Hosp i tal Infect ion Contro l Comm ittee

Objective

To facilitate the effective

prevention,detection,and

control

of healthcare associated infection amongpatients, healthcare workers and visitors.
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Infect ion Contro l Comm it tee

Responsibilities:

Formulates, updates, and implements infection

control policies and procedures:- Hand hygiene

- Disinfection & sterilization

- Isolation policy- Antibiotic Use

- Personnel Health

- Dietary

- Linen & Laundry

- Waste Management- Environmental Care


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Infect ion Con tro l Comm ittee

Responsibilities:

Surveillance

- nosocomial infection

- antimicrobial resistance

- proper infection control practice

- personnel health

- outbreaks

- environment


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Infection Control Committee

Training and education of healthcare staff

Conducts orientation of new staff Conducts activities for updates on infection

control for staff regularly

Disseminates necessary information


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Organizational Structure; ICC

Medical Director

ICC----------------------------------

Nursing Service Medical Services Administrative

Membership of the Infection
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Control Committee

Chairperson

Infection control doctor

Infection control nurse

Representative from:

Administration

Clinical departments (medicine, pediatrics, surgery,

obstetrics and gynecology, Infectious Disease Section) Microbiology laboratory

Nursing service
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Control Committee

Representative from:

Pharmacy

Employee Health Service

Central Sterilization and Supply Department

Engineering

Dietary Department

Housekeeping

Linen and laundry

Waste Management
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The Infection Control Team

IC Physician

IC Nurse

Microbiologist

Epidemiologist


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An effective ICT:

Maintains direct access to a representative of the Hospital

Director/Administrator

Responsible to the ICC

Functions on a daily basis

Has access to appropriate facilities to enable it to perform

its duties Have an efficient mechanism of reporting significant

hospital outbreaks
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Responsibilities

Educates, trains, and advises staff on all aspects

of infection control

Conducts surveillance activities:

Nosocomial infections Antibiotic resistance

Infection control practices


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Establishing An

Infection Control Program Identify interested and key hospital

personnel as members of the ICC/ICT

Accomplish a written description of theprogram (Infection Control Plan)

Goals, objectives, structure

Specific surveillance, prevention, control,education, and training activities


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Establishing An

Infection Control Program Formulate written policies and procedures

study existing practices

modify existing policies as needed consider difficulties during implementation

after hospital-wide consultation

Implement changes gradually

Have the cooperation of the staff


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Establishing An

Infection Control Program Formulate written policies and procedures

simple, easy to follow, common sense

consider costs and availability of supplies maintain standard of care

incorporate written policies in the IC manual

Monitor and evaluate periodically


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Establishing An

Infection Control Program Disseminate information

Implement and monitor

Annual evaluation on the IC program Assess the activities

Assess accomplishments

Identify any changes in goals, objectives,structure

Assess the value of the program to the hospital


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INFECTION CONTROL is


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In fect ion Con tro l should be

..... a WAY of L IFE!


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Thank You!

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