Hospital Infection Control 2008

Philippine Hospital Infection Control Society (PHICS), Inc.

HOSPITAL INFECTION

CONTROL

Cecilia S. Montalban, MD, MScCTM


INFECTION• the state or condition in which the

body or part of the body is invaded by a pathogenic agent (bacteria, virus, parasites etc.) which under favorable conditions multiplies and produces injurious effects


NOSOCOMIAL INFECTION

• latin word “nosocomium” meaning hôspital • synonymous to hospital-acquired infection• infection acquired 48 hours after

admission to hospital (not present or incubating at the time of admission)

• acquired while in the hospital and developed after discharge


Common Sites of Nosocomial Infections

Urinary tract

Respiratory tract

Gastrointestinal

Blood stream

Skin, Wound, Burn

Surgical wound infection

Others


Factors Promoting Nosocomial Infection

ageduration of hospitalizationsurgery (type of operation)immune status: chemotherapy, radiation therapy, malignancydiagnostic technique/ proceduresenvironmentpersonnelpatient


The “C ST” of Nosocomial Infection

PERSONNEL

• Need for hospitalization

• Income loss

• Pain and suffering

• Disfigurement/Disability

• Death


The “C ST” of Nosocomial Infection

INSTITUTIONS

• Loss of revenue

• Extra duty

• Liability insurance

• Malpractice

• Reputation


BSI Pneumonia UTI

Extra days

confinement15 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.


How do infections occur in hospital setting ?

AGENTAGENT

SUSCEPTIBLESUSCEPTIBLEHOSTHOST

MEANS OF MEANS OF TRANSMISSIONTRANSMISSION


AGENTAGENT



AGENTS

GRAM NEGATIVE RODS

GRAM POSITIVE COCCI

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


Sources of Agents of Nosocomial InfectionsEXOGENOUS• Hands• Instruments• Catheters• Respiratory

equipments• Transfusions• IV system• Linen• Air

ENDOGENOUS• Oropharynx• Respiratory• Gastrointestinal• Skin


Factors Promoting Endogenous Infections

• Operations

• Catheters

• Foreign bodies

• Chemotherapy

• Immunosuppression

• Pre-existing disease


AGENTAGENT




Means of Transmission of Nosocomial Infections

Contact - direct or indirect

Airborne - measles, varicella, TB

Droplet - meningococcemia

Vector - insects or animals

Vehicle - food, water, blood,

medication


MEANS OF TRANSMISSIONOF NOSOCOMIAL INFECTIONS

CONTACTCONTACTA. Direct ContactA. Direct Contact

- occurs when one person - occurs when one person touches anothertouches another

- direct contact is an ongoing - direct contact is an ongoing process in the hospitalprocess in the hospital

- best vehicle : - best vehicle : Hands


MEANS OF TRANSMISSIONOF NOSOCOMIAL INFECTIONS

CONTACTCONTACTB. Indirect ContactB. Indirect Contact

- occurs when a person touches - occurs when a person touches an inanimate object an inanimate object contaminated by an infected contaminated by an infected patientpatient


AGENTAGENT

SUSCEPTIBLESUSCEPTIBLEHOSTHOST




Factors that Increase Host Susceptibility to Nosocomial Infections

• Chronic underlying diseases• Immune deficiency states

– Malignancies– Therapeutic measures– Immunosuppression– Antibiotic therapy

• Invasive devices• Surgery• Age


AGENTMeans of

TransmissionSusceptible

HostBacteriaBacteriaVirusVirusFungiFungi

CONTACTCONTACTAIRBORNEAIRBORNEDROPLETDROPLETVEHICLEVEHICLEVECTORVECTOR

DiseaseDisease


BASIC PRINCIPLES IN INFECTION CONTROL


AGENTAGENT

SusceptibleSusceptibleHOSTHOST

Means ofMeans ofTransmissionTransmission

The The CHAIN of CHAIN of

INFECTIONINFECTION


AGENTAGENT



Breaking theChain of Infection


• The hands should be washed after handling infectious materials (e.g. bed linen, dressings, secretion and excretions).

• The skin of the patient should be disinfected before invasive procedures

• Emphasize HANDWASHING for personal hygiene

Basic Principles in Infection Control




Rational Use of Devices

- Avoiding or removing factors that impair host defenses.

- Invasive devices should be avoided or should be removed as soon as possible



Isolation Techniques based on method of spread

Protective or Reverse Isolation

Rationale: decreasing the contact of the immunocompromised host to potential pathogens

Immunotherapy, Immunizations and other methods of reconstituting patient’s immune response may be attempted


• The environment should be HOSTILE to the multiplication of pathogens, i.e. clean, dry, exposed to light and well ventilated.

• All infectious materials (e.g. linen, clinical waste, sharps) should be safely contained, decontaminated or destroyed.



• All instruments and equipment should be clean and dry. Invasive items should be sterilized and items in contact with mucous membranes, body fluids and potentially infectious materials should be disinfected.

• Food should be hygienically

prepared, properly cooked and

stored at low temperatures until

used.



• Susceptible patients or sites should be protected from pathogenic microorganisms: i.e. aseptic technique practice during wound dressing, or procedures

• Use of disposable supplies and equipment in an attempt to limit the spread of infection by this means

• Control of insects and rodents that serve as vectors in the spread of microorganisms





Hand HygieneEnvironmental CareWaste management

Disinfection and Sterilization

Hand HygieneRational use of Devices

IsolationImmunization,

ImmunotherapyProphylaxis

Breaking theChain of Infection

Hand HygieneAseptic Technique

practiceEnvironmental Care

Disinfection and Sterilization

AGENTAGENT


The Health Care Worker (HCW) should be aware of how infection is transmitted and the factors involved in the process

The HCW should be able to implement the MOST effective and applicable measures to prevent and control infection in his place of work

The HCW should have the proper attitude of infection control


Hospital Infection Control Hospital Infection Control CommitteeCommittee



Hospital Infection Control CommitteeHospital Infection Control Committee

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


Hospital Infection Control CommitteeHospital Infection Control Committee

Objective

To facilitate the effective

prevention,

detection, and

control

of healthcare associated infection among patients, healthcare workers and visitors.


Infection Control CommitteeInfection Control Committee

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



Responsibilities:

Surveillance- nosocomial infection- antimicrobial resistance- proper infection control practice- personnel health- outbreaks- environment



Training and education of healthcare staff

• Conducts orientation of new staff• Conducts activities for updates on infection

control for staff regularly• Disseminates necessary information


Organizational Structure; ICCOrganizational Structure; ICC

Medical DirectorICC----------------------------------

Nursing Service Medical Services Administrative


Membership of the Infection Membership of the Infection Control CommitteeControl 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


Membership of the Infection Membership of the Infection Control CommitteeControl Committee

Representative from: Pharmacy Employee Health Service Central Sterilization and Supply Department Engineering Dietary Department Housekeeping Linen and laundry Waste Management


The Infection Control TeamThe Infection Control Team

IC PhysicianIC NurseMicrobiologistEpidemiologist



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



Responsibilities• Educates, trains, and advises staff on all aspects

of infection control

• Conducts surveillance activities:• Nosocomial infections• Antibiotic resistance• Infection control practices


Establishing An Establishing An Infection Control ProgramInfection Control Program

• Identify interested and key hospital personnel as members of the ICC/ICT

• Accomplish a written description of the program (Infection Control Plan)• Goals, objectives, structure• Specific surveillance, prevention, control,

education, and training activities



• 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



• 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



• 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


INFECTION CONTROL is…


Infection Control should be

..... a WAY of LIFE!


Thank You!

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Hospital Infection Control 2008

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