HOSPITAL ACQUIRED INFECTIONS

BY Dr. ATIULLAH KHAN MIMER medical college

DEFINITION Infections that develop within a hospital or

are produced by microorganisms,acquired during hospitalization, within 48hrs.

Also called as “NOSOCOMIAL INFECTIONS.”

‘Nosus’ means disease.

‘Kameion’ means to take care of.

DEFINITION BY C.D.C Infections that the patients acquire during the course of receiving treatment for other conditions, or acquired by the Healthcare Workers while performing their duties in healthcare settings.

Public health importance Major public health problem

Incidence -2% to 12% in developed countries

The incidence depends on type of hospital, type of patients and type of surgeries performed

STATUS IN INDIARisk of infections in India.

[Current scenerio as per apiindia.org]

Approx. 19,900 neonatal deaths/year due to sepsis.

5-10% of patients admitted to acute care hospitals acquire infections.

2 million patients/year affected.

90,000 deaths/year

1/4th of nosocomial infections occur in ICUs.

70% are due to antibiotic resistant organisms

Factors Influencing H.A.I. The microbial agent

Patient susceptibility

Enviromental factors

HOST FACTORS

THE AGENT

EPIDEMIO-

LOGICAL INTERAC

T-ION

ENVIRONMEN

T

SOURCES OF INFECTION

2 SOURCES :

EXOGENOUS• Outside the

human bodyENDOGENOUS• By Normal human

flora

• Caused by organisms acquired by exposure to hospital personnel, medical devices or hospital environment.

EXOGENOUS

INFECTIONS

• Caused by organisms that are present as a part of normal flora of the patient.

ENDOGENOUS

INFECTIONS

Richards, MJ. 1999. Crit Care Med 27; 887.

0

5

10

15

20

25

30

35

Overall ICU

UTIPneumoniaSWIBloodstreamOther

Gram +veStaphylococcus aureusStaphylococcus epidermidis

Gram -veEnterobacteriaceae Pseudomonas aeruginosaAcinetobacter baumanniMycobacterium tuberculosis

BACTERIA

Pseudomonasaeruginosa

Enterococcus

Coag-neg staphylococcl

E-coli

Staphylococcus aureus

Other

COMMON BACTERIAL AGENTS

(9%)(10%)

(11%) (12%)

(13%)

45%)

SURGICAL SITE INFECTIONS

Any purulent discharge, abscess, or spreading cellulitis at the surgical site during the month after the operation.

The infection is usually acquired during the operation itself; either exogenously (e.g. from the air, medical equipment, surgeons and other staff), endogenously from the flora on the skin or in the operative site or, rarely, from blood used in surgery

URINARY TRACT INFECTIONS

Positive urine culture (1 or 2 species) with at least 105 bacteria/ml, with or without clinical symptoms.

MOST COMMON NOSOCOMIAL INFECTION

80% of infections are associated with the use of an indwelling bladder catheter

RESPIRATORY INFECTION

Respiratory symptoms with at least two of the following signs appearing during hospitalization:

Cough Purulent sputum New infiltrate on chest

radiograph consistent with infection.

BLOOD STREAM INFECTIONS

Represent a small proportion of nosocomial infections.

Case fatality : >50% Organisms involved :

Multi resistant coagulase- negative Staphylococcus

Candida spp.

MODES OF TRANSMISSION

ROUTES OF SPREAD

CONTACT AIR BORNE

EXOGENOUS

CONTACT TRANSMISSION(MOST COMMON MODE OF TRANSMISSION)

CONTACT

DIRECT INDIRECTHANDS,AUTOINOCULATION,EQUIPMENT.

BEDPANS,DRESSINGS,CONTAMINATED GLOVES

Direct via (physical contact) Hands & clothing Droplet contact followed by

autoinoculation Clinical equipment

Indirect via contaminated articles

Bedpans, Instruments like needles, dressings, contaminated gloves,etc. bowls, jugs,

1. Contact (most common)

AIR BORNE TRANSMISSION

• DROPLET NUCLEI IN THE ATMOSPHERE

• RESPIRATORY SECRECTIONS ON SURFACE (FOMITES)

EXOGENOUS INFECTIONS SITESIN HOSPITAL-INFECTIONS

PREVENTING NOSOCOMIAL INFECTIONS

ADMINISTRATIVE MEASURES Formation of a hospital aquired “

INFECTION CONTROL COMMITTEE” to formulate the policies regarding admission of infectious cases, isolation facilities & disinfection procedures.

Formation of a CSSD (Central Sterile Supply Department) in every hospital.

Infection Control Committee

The hospital ICC is charged with the responsibility for the planning, evaluation of evidenced-based practice and implementation, prioritization and resource allocation of all matters relating to infection control.

Infection Control Nurse (ICN)

Infection Control Team

Infection Control Doctor (ICD)

Role of infection control teams

Education and training Development and dissemination of

infection control policy Monitoring and audit of hygiene Clinical audit

C.S.S.D (Central Sterile Supply Department)

Supply of sterile instrument & material for dressing & procedure carried out in the wards and departments.

Sterilization of instruments & linen for use in O.T.

Disinfection & Sterilization of medical equipment.

Selection & distribution of single use sterile supplies such as catheters, suction tubes, syringes.

Goals of infection control Ensure that health professionals

understand how pathogens can be transmitted in the working environment [patient to healthcare worker, healthcare worker to patient &patient to patient]

Apply current scientifically accepted infection control principles

Minimize opportunity for transmission of pathogens to patients and healthcare workers

ISOLATION

Infectious patients MUST be isolated.

Patients susceptible to infection should not be placed in the beds next to patients who are a source of infection.

MEASURES BY HOSPITAL STAFF Those suffering from infectious

ailments should be kept away from work until completely cured.

They should be careful about PERSONAL HYGIENE.

Aprons & Outer clothing should be regularly changed.

HAND WASHING

HAND HYGIENEHANDS ARE THE MOST IMPORTANT VEHICLES OF HAI TRANSMISSION• THOUSANDS OF PEOPLE DIE EVERYDAY FROM

INFECTIONS WHILE RECEIVING HEALTH CARE • MOST IMPORTANT MEASURE TO AVOID THE

TRANSMISSION OF HARMFUL MICROORGANISMS.

ANY HEALTHCARE WORKER/PERSON INVOLVED IN DIRECT/INDIRECT PATIENT CARE

WHY?

WHO?

5y13

Why Don’t Staff Wash

their Hands(Compliance estimated are less than

50%)

WHY DON’T STAFF WASH HANDS?

• THE COMPLIANCE ESTIMATED IS LESS THAN 50%

• SKIN IRRITATION• WEARING GLOVES• TOO BUSY FOR REGULAR HAND

WASHING• LACK OF APPROPRIATE STAFF• Being a physician

DUST CONTROL

Dust is released during SWEEPING, DUSTING & BEDMAKING.

Suppression by WET DUSTING VACUUM CLEANING

PROPER DISPOSAL OF HOSPITAL WASTE

COLOR WASTE TREATMENT

YELLOW Human & animal anatomical waste/Microbiology waste and

soiled cotton/dressings/linen/bedding

etc.

INCINERATION/ DEEP BURIAL

RED Tubing/catheters/i.v. sets etc. AUTOCLAVE/MICROWAVE/

CHEMICAL TREATMENT

BLUE/ WHITE

Waste sharps (needles,syringes,scalpels,blade

s etc.)

AUTOCLAVE/MICROWAVE/

CHEMICAL TREATMENT/

DESTRUCTIONBLACK Discarded medicines/

cytotoxic drugs/incineration ash/chemical waste

DISPOSAL IN LAND FIELDS

DISINFECTION

Disinfection prevents transmission of organisms between patients.

3 LEVELS OF DISINFECTION:

HIGH LEVEL - destroys all the microorganisms except heavy contamination by bacterial spores.

INTERMEDIATE LEVEL – inactivates M.tuberculosis, vegetative bacteria, most viruses & fungi.

LOW LEVEL – kills most bacteria, some viruses & some fungi.

STERILISATION

Operationally, defined as decrease in microbial load to 10-4.

Done for Medical devices penetrating sterile body sites Parenteral fluids Medications Reprocessed equipment

The objects must be wrapped after sterilization to maintain its viability for longer durations of time.

CONTROL OF DROPLET INFECTION

Use of face-mask

Proper bed-spacing

Prevention of overcrowding

Ensure adequate ventilation

IMPROVING NURSING TECHNIQUES

BARRIER NURSING is the effective measure.

Its Aim is to protect medical staff against infection by patients, especially with highly infectious diseases.

An attempt should be made to achieve and maintain an average count of 10-

15 bacteria/cubic foot of air in hospital.

Less than 5 bacteria/cubic foot – minimal risk of infection.

More than 35 bacteria/cubic foot – high risk of infection

Guideline to evaluate the floor cleaning procedurebased on REPLICATE ORGANISM DETECTION &COUNTING (R.O.D.A.C plate count)

0-25 bacteria/cubic foot - good floor cleaning procedure.

26-50 bacteria/cubic foot – satisfactory.

>50 bacteria/cubic foot – not satisfactory.

MANUAL STEAM STERILIZER

SEMI-AUTOMATIC STEAM STERILIZER

AUTOMATIC STEAM STERILIZER

ETO(ETHYLENE TRIOXIDE) STERILIZER

WASHER DISINFECTOR

ULTRASONIC CLEANER

GLOVE WASHER

GLOVE DRYER

GLOVE POWDERING MACHINE

BIBLIOGRAPHY Park’s Textbook of Preventive & Social

Medicine 23rd edition Prevention of Hospital Acquired Infections

WHO GUIDELINES Bennett and Brachman’s Hospital Acquired

Infections by William R. Jarvis CDC – www.cdc.gov/cdc.htm Harrisons textbook of medicine 18/e pg 1112 Hospital Administration by Francis & de ’Souza Instruments Picture from saifaee medical college

Etawah, website

THANK YOU