Health Care-Associated Infections in King Faisal Hospital

Christine Mukashema

Learning Objectives

• To be aware about the HCAI problem• Describe principles of control measures

What is Health Care-Associated Infections?

• Also referred to as “nosocomial” or “hospital” infection “An infection occurring in a patient during the

process of care in a hospital or other health-care facility which was not present or incubating at the time of admission. This includes infections acquired in the health-care facility but appearing after discharge, and also occupational infections among health-care workers of the facility”

Why this presentation HCAI places a serious disease burden and significant

economic impact on patients and health-care systems

No health-care facility, no country, no health-care system in the world can claim to have solved the problem

Estimated rates of HCAI worldwide– Worldwide: • over 1.4 million people suffering HCAI

– In developed world: • 5–10% of patients acquire one or more infections

– In developing countries: • risk of HCAI is 2–20 times higher than in developed

countries • exceed 25% of patients affected by HCAI

– In intensive care units• 30% of patients • 44% of attributable mortality

Most frequent KCAI in KFH2012

Klebsiella 19.5%

Acinetobacter: 10.5%

Pseudomonas: 7.6%

Staphylococcus Aureus 7.4%

E.Coli: 34.7% 34.7%

Infection rate 11%

2011

Klebsiella  17.6%

Pseudomonas 7.6%

Acinetobacter 5.5%

Staphylococcus Aureus 8.2%

E.Coli 37.7%

Infection rate 9.4%

Most frequent in KFHThe Respiratory tract: – procedures and equipment associated with intubation,

ventilator support and tracheotomy– management of TB…

Urinary tract: – procedures and equipment associated with urinary

drainage systems– indwelling catheters – catheters and their care

Intravascular devices:– procedures and equipment associated with peripheral

venous lines, CVCs….

Surgical wounds: – procedures and equipment associated with their care

 

Some HAI in ICU(2011- May2012)

SPECIMEN KLEBSIELLA PSEUDOMONAS ACIENTOBACTER

BLOOD 3 1 2

CSF 4 0 2

FLUID 6 4 22

PUS 9 7 2

SPUTUM 1 3 1

URINE 8 3 5

Total 31 18 34

Some HAI in Surgical (2011- May 2012)

SPECIMEN KLEBSIELLA PSEUDOMONAS ACIENTOBACTER

BLOOD 5 5 5

CSF 1 0 1

FLUID 4 6 18

PUS 9 14 18

SPUTUM 1 1 3

URINE 15 8 5

TISSUE 2

Total 35 34 52

Organisms isolated during 8 months by ward

Ward NamesJanuary

February March April May June July August Total Percent

age

Surgical 19 15 18 30 12 26 22 17 159

33%ICU 15 13 10 6 9 1 5 14 68

14%Medical 15 16 10 11 9 7 23 15 106

22%Paediatric 7 9 7 7 3 15 19 10 77 16%

NICU 1 5 2 1 9

2%Urusaro 2 3 3 2 10

2%Maternity 4 2 2 2 4 2 2 3 21 4.3%

HDU 8 5 1 2 1 8 25 5%

Haemodialysis 1 4 2 1 2 10 2%

Total 69 60 49 65 48 59 76 70 485

Where we can found those Microbes?

• Bed rails• Bedside tables• Ventilators• Infusion pumps• Mattresses• Pillows• Air humidifiers • Patient monitors

• X-ray view boxes• Curtain rails• Curtains• Equipment carts• Sinks• Ventilator circuits• Floor mops• HCWs

Possible causes of HCAI in KFH• Poor Hand Hygiene • Knowledge of the policies, guidelines/standards• No in ward training• No orientation in the department• High turnover of staff• Lack of staff• Negligence/ignorance• Stock outs / recycling/ lack of instruments• Staff motivation• Cleaning of instruments/ soaking of instruments• Dilution of chemicals used for cleaning- bed area and the instruments• No guideline on screening patients transferred from other institutions• Personal hygiene – staff uniform and cleaning• Labeling and changing of invasive• Isolation Precautions (sometimes not possible)• Use of PPE• Frequent stock outs of IPC items

Antibiotic sensitivity

• Bad usage of antibiotic causes drug resistance • Not given in – Appropriate time– Appropriate dose– Appropriate course– Appropriate antibiotics

Most frequent infection sites & their risk factors

LOWER RESPIRATORY TRACT INFECTIONSMechanical ventilationAspirationNasogastric tubeCentral nervous system depressantsAntibiotics and anti-acidsProlonged health-care facilities stayMalnutritionAdvanced ageSurgeryImmunodeficiency

13%

BLOOD INFECTIONSVascular catheterNeonatal ageCritical care Severe underlying diseaseNeutropeniaImmunodeficiencyNew invasive technologiesLack of training and supervision

14%

SURGICAL SITE INFECTIONSInappropriate antibiotic prophylaxis

Incorrect surgical skin preparationInappropriate wound care

Surgical intervention durationType of wound

Poor surgical asepsisDiabetes

Nutritional stateImmunodeficiency

Lack of training and supervision 17%

URINARY TRACT INFECTIONSUrinary catheter

Urinary invasive proceduresAdvanced age

Severe underlying diseaseUrolitiasis

PregnancyDiabetes

34%

Most common sites of HCAI

and the risk factors

LACK OF

HAND HYGIEN

E

Hand transmission

– Hands are the most common vehicle to transmit health care-associated pathogens

– 5 sequential steps to transmit of health care-associated pathogens from one patient to another via health-care workers’ hands

5 stages of hand transmission

Germs present on patient skin and immediate environment surfaces

Germ transfer onto health-care worker’s hands

Germs survive on hands for several minutes

Suboptimal or omitted hand cleansing results in hands remaining contaminated

Contaminated hands transmit germs via direct contact with patient or patient’s immediate environment

One Two Three Four Five

The impact of HCAI

HCAI can cause:– more serious illness– prolongation of stay in a

health-care facility– long-term disability– excess deaths – high additional

financial burden– high personal costs on

patients and their families

Study on the Efficacy of Nosocomial Infection Control (SENIC)

• >30% of HCAI are preventable

With infection control

-31%-35%-35%

-27%-32%

Without infection control

14%9%

19%26%

18%

LRTI SSI UTI BSI Total

Relative change in NI in a 5 year period (1970–1975)

0

10

20

30

-40

-30

-20

-10

%

Haley RW et al. Am J Epidemiol 1985

Prevention of HCAI

– At least 50% of HCAI could be prevented – Validated and standardized prevention strategies

have been shown to reduce HCAI– Most solutions are simple and not resource-

demanding and can be implemented in developed, as well as in transitional and developing countries

Possible solutions

1. A proper orientation in all departments2. Regular training of staff in IPC3. Monthly IPC audit, hand washing audit4. Avail all necessary items from the management5. Motivation of staff6. A proper reporting of infections7. Administration to facilitate repair and/or

establishment of hand washing facilities in all areas8. To put in place some measures if policies/

guidelines are not followed

Possible solutions9. Implementation of IPC policies and guidelines in all

department10. To procure all necessary items and equipments

needed11. To recruit enough nurses12. To follow policy on the use of antibiotics in the

hospital13. Environmental decontamination14. The HoU, NUMs should follow closely their staff

(close supervision)

Why should you clean your hands?

– Any health-care worker, caregiver or person involved in patient care needs to be concerned about hand hygiene

– Therefore hand hygiene concerns you!– You must perform hand hygiene to:

– protect the patient against harmful germs carried on your hands or present on his/her own skin

– protect yourself and the health-care environment from harmful germs

The “My 5 Moments for Hand Hygiene” approach