Date post: | 18-Feb-2017 |
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Health & Medicine |
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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