• Dr.T.V.Rao MD

HOSPITAL INFECTIONS FACTS, CONCERNS, AND PREVENTION

DR.T.V.RAO MD 1

NOSOCOMIAL INFECTIONS

Nosocomial comes from the Greek word

nosokomeion meaning hospital (nosos

= disease, komeo = to take care of). This

type of infection is also known as a

hospital-acquired infection (or more

generically healthcare-associated

infections

DR.T.V.RAO MD 2

WHAT ARE HOSPITAL ACQUIRED

INFECTIONS

An infection acquired in hospital by a patient

who was admitted for a reason other than that infection . An infection occurring in a patient in a hospital or other health care facility in whom the infection was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among

staff of the facility DR.T.V.RAO MD 3

Nosocomial infections are widespread. They are important contributors to morbidity and mortality. They will become even more important as a public health problem with increasing economic and human impact

NOSOCOMIAL INFECTIONS ON

PUBLIC HEALTH

DR.T.V.RAO MD 4

Increasing numbers and crowding of people. More frequent impaired immunity (age, illness, treatments). New microorganisms.

Increasing bacterial resistance to antibiotics contributed as emerging problem

CROWDING A MAJOR FACTOR

DR.T.V.RAO MD 5

WHEN THE NOSOCOMIAL

INFECTIONS MANIFEST

Majority of such infections

become evident during their stay

in the Hospital or some times only

after their discharge from the

patient.

DR.T.V.RAO MD 6

HOW AND WHEN HOSPITAL

ACQUIRED INFECTIONS OCCUR.

Nosocomial infections are infections which are a result of treatment in a hospital or a healthcare service unit, but secondary to the patient's original condition. Infections are considered Nosocomial if they first appear 48 hours or more after hospital admission or within 30 days after discharge.

DR.T.V.RAO MD 7

COMMONLY OCCURRING MICROORGANISMS IN

HOSPITAL INFECTIONS

DR.T.V.RAO MD 8

The patient is exposed

to a variety of

microorganisms

during hospitalization.

Contact between the

patient and a

microorganisms does

not by itself necessarily

result in the

development of clinical

disease — other factors

influence the nature

and frequency of

Nosocomial infections.

MICROORGANISMS AND

NOSOCOMIAL INFECTIONS

DR.T.V.RAO MD 9

Escherichia coli

Klebsiella,

Serratia,Proteus spp

Pseudomonas

aeruginosa

Enterococcus spp

Candida albicans

URINARY TRACT INFECTIONS

DR.T.V.RAO MD 10

RESPIRATORY INFECTIONS

Hemophilus influenzae

Streptococcus pneumonia

Staphylococcus aureus

Enterobacteriaceae

Respiratory viruses

Fungi, Candida spp

Aspergillus's spp

DR.T.V.RAO MD 11

SKIN SEPSIS AND WOUNDS

Staph aureus

Streptococcus pyogenes

E.Coli

Proteus spp

Anaerobic bacteria

Enterococcus spp

Coagulase negative

Staphylococcus

DR.T.V.RAO MD 12

GASTRO INTESTINAL INFECTIONS

Salmonella

serotypes

Clostridium

difficile

Norwalk like

viruses

DR.T.V.RAO MD 13

The likelihood of exposure leading to infection depends partly on the characteristics of the microorganisms, including resistance to antimicrobial agents, intrinsic virulence, and amount (inoculum) of infective material.

DRUG RESISTANCE – NOSOCOMIAL

INFECTION

DR.T.V.RAO MD 14

PATHOPHYSIOLOGY

Within hours of admission, colonies of

hospital strains of bacteria develop in the

patient's skin, respiratory tract, and

genitourinary tract. Risks factors for the

invasion of colonizing pathogens can be

categorized into 3 areas: iatrogenic,

organizational, and patient-related

DR.T.V.RAO MD 15

Iatrogenic risk factors include pathogens on the hands of medical personnel, invasive procedures (eg, incubation and extended ventilation, indwelling vascular lines, urine catheterization), and antibiotic use and prophylaxis.

IATROGENIC RISK

DR.T.V.RAO MD 16

ORGANIZATIONAL

Organizational risk

factors include

contaminated air-

conditioning systems,

contaminated water

systems, and staffing

and physical layout of

the facility (eg, nurse-

to-patient ratio, open

beds close together). DR.T.V.RAO MD 17

PATIENT ASSOCIATED

Patient risk factors

include the severity of

illness, underlying

immunocompromised

state, and length of

stay.

Prolonged stay in the

hospital is a Major

contributing factor

DR.T.V.RAO MD 18

A susceptible host and appropriate inoculum of infecting microorganism with an appropriate route of transmission contributed in majority of cases

ROUTES OF TRANSMISSION OF

INFECTION

DR.T.V.RAO MD 19

AIR – BORNE ROUTE From respiratory tract via

talking, coughing, sneezing

From the skin by natural shedding of the skin scales during would dressing or bed making.

From aerosols from equipment, respiratory apparatus, air-conditioning plants.

DR.T.V.RAO MD 20

In direct contact spread from person to person

By indirect contact spread via contaminated hands or equipment.

Clothing of staff,

Urinary catheters, contaminated with hands of the operator may introduce organisms, or patients own flora from urethra may contribute to infection

CONTACT SPREAD

DR.T.V.RAO MD 21

FOOD BORNE SPREAD

From hospital kitchen, or in special diets, infant feeds, kitchen, or commercial supplies

Mechanical vectors flies, cockroaches or insects, or rodents act as carriers of infection.

DR.T.V.RAO MD 22

The accidental

transmission of

infections as HIV,

HBV,and HCV by

needle stick injuries

is documented

Syphilis and malaria

a concern in high

prevalence areas

BLOOD BORNE SPREAD

DR.T.V.RAO MD 23

Lower bowel surgery,

Self infection may occur

due to flora from nose,

Staphylococcus may be

introduced into wounds.

Cross infection

between patients

occur due to spread

of Staphylococcus or

coli forms

SELF INFECTIONS AND CROSS

INFECTIONS

DR.T.V.RAO MD 24

OTHER CONTRIBUTING FACTORS

Surgeons punctured

surgical gloves, or

moistened gown,

imperfectly sterilized

surgical instruments, or

by airborne theatre

dust. Faulty wound

dressings may cause

infections.

DR.T.V.RAO MD 25

Self infection

from patient’s

own flora from

Bowel can be

major contributor

of infections in

bowel surgery.

PATIENTS OWN FLORA TOO INFECTIVE

DR.T.V.RAO MD 26

OTHER SOURCE OF HOSPITAL

INFECTIONS

Hospital environment, includes defective constructions,

People their behavior has great impact. Objects, food, water, Air in the hospital too contribute to infections.

DR.T.V.RAO MD 27

CROSS INFECTION

Many different bacteria,

viruses, fungi and

parasites may cause

Nosocomial infections.

Infections may be caused

by micro organism

acquired from another

person in the hospital

(cross-infection) or may

be caused by the patient’s

own flora (endogenous

infection).

DR.T.V.RAO MD 28

Some organisms

may be acquired

from an inanimate

object or

substances

recently

contaminated from

another human

source (environmental

infection).

USED/CONTAMINATED SYRINGES A

GREAT THREAT IN DEVELOPING WORLD

DR.T.V.RAO MD 29

CHANGING TRENDS IN INFECTION

ETIOLOGY

With advances in more elaborate surgery and

intensive care, with combined use of broad

spectrum antibiotics and immunosuppressive

drugs, Gram Negative bacteria increased in

importance

Pseudomonas aeruginosa gained importance

in causing infection in compromised patients.

They exhibit natural resistance to antibiotics

and antiseptics DR.T.V.RAO MD 30

EMERGING INFECTIOUS AGENTS

A group of Microbes

that played no role in

the past have emerged.

1 Coagulase negative

Staphylococci

2 Acinetobacter

baumanii

DR.T.V.RAO MD 31

MICROBES FROM ENVIRONMENT

The dissemination from environment such as cooling towers and hot water system is proving a threat with Legionella pneumophila causing infections of respiratory systems

DR.T.V.RAO MD 32

VIRUS TOO PLAY A IMPORTANT ROLE

Awareness on risk of

Blood born viruses

including

Hepatitis B, C and HIV

essential

CMV virus in association

with organ and cellular

transmission

DR.T.V.RAO MD 33

IATROGENIC SPREAD A CONCERN

The possible risk of

iatrogenic spread

of Prions causing

Creuzfeldt-Jacob

disease is a

concern

DR.T.V.RAO MD 34

COMMON SITES ASSOCIATED WITH

ETIOLOGICAL AGENTS

Urinary tract

Surgical wounds

Respiratory tract

Skin (especially burns)

Blood (bacteraemia)

Gastrointestinal tract

Central nervous system

DR.T.V.RAO MD 35

COLLECTION OF DATA IN CROSS

INFECTIONS

Always collect information and document information on

1 Patient details

2 Site and extent of infection

3 Date of admission – operative procedure

first recognition of infection

4 Specimen and laboratory isolates and

typing results

5 Ward and staff details.

DR.T.V.RAO MD 36

The basic responsibility of any good hospital remain with establishment of good infection control policies, which can always be achieved with

1 An infection control committee

· 2 An Infection team

PREVENTION AND CONTROL

DR.T.V.RAO MD 37

Should meet regularly to formulate and update policies for the whole hospital on all matter which have bearing on infection control and to mange outbreaks of Nosocomial infection

INFECTION CONTROL COMMITTEE

DR.T.V.RAO MD 38

INFECTION CONTROL TEAM

Which will function under the guidance of Infection control Doctor.

A Medically qualified Microbiologist, who will take responsibility of day to day for the policies formulated

DR.T.V.RAO MD 39

To do surveillance and infection monitoring of hygiene practices.

Educate the Medical and Paramedical staff on policies relating to prevention of infection, and safe procedures

THE FUNCTIONS OF THE COMMITTEE

DR.T.V.RAO MD 40

Is the key member of

the team

Maintain the close

working relations

between Microbiology

Laboratory, different

clinical services and

supportive services like

laundry, pharmacy and

engineering

INFECTION CONTROL NURSE

DR.T.V.RAO MD 41

ALL ARE CAMPAIGNERS OF SAFE

PRACTICES

It is the minimal

responsibility of the

members to

campaign on issues

related to safe

practices including

Hand washing

DR.T.V.RAO MD 42

Fundamental importance lies with supply of sterile instruments, dressings and fluids.

A availability of single use syringes, needles, catheters and drainage bags to be assured and planned for the regular supplies .

DECONTAMINATION AND STERILIZATION

DR.T.V.RAO MD 43

ASEPTIC TECHNIQUES A no touch technique when

dealing with sterile equipment

coupled with strict personal

hygiene.

A strict rules laid when dealing

the patients in the operation

theatre and other procedures

such as wound dressing and

insertion of IV and urinary

catheters.

DR.T.V.RAO MD 44

CLEANING AND DISINFECTION

Basic cleaning, waste

disposal, and laundry carry

priority.

The use of chemical

disinfectants for wall floors,

and furniture is warranted

in special circumstances,

such as spillages, of body

fluids from patients with

blood born viral infections

DR.T.V.RAO MD 45

All the Mop heads and cloths used in crucial areas should be heat disinfected and stored in dry places after use.

Bed pans washers and disinfectants and dishwashers should be monitored to ensure reliable performance

CARE OF MOP HEADS AND OTHER

ITEMS

DR.T.V.RAO MD 46

Hand washing is a most

important procedure

which should be

practiced by health care

worker, gram – ve

bacteria on the hands

of the staff is an

important factor in the

spread of hospital

infection

SKIN DISINFECTION AND

ANTISEPTICS

DR.T.V.RAO MD 47

HAND WASHING Thorough hand washing

after any procedure

involving nursing care or

close contact with the

patient is essential.

Alchool based hand

antiseptics gaining

importance where washing

with water and soap are

not practicable.

DR.T.V.RAO MD 48

Gloves may be worn for

any dirty contact

procedure such as

emptying a urinary

cans, or bed pans,

however it should not

be forgotten gloved

hand may also become

colonized by transient

hospital flora.

WEARING A GLOVE

DR.T.V.RAO MD 49

DISINFECTION POLICIES

All the hospitals should create disinfection policies which suit circumstances and economic resources.

The procedures and products should have a limited range of options, and chemicals to be used only in desired circumstances.

The policies should take into consideration surgical instruments, heat disinfection, Laundry, crockery and cleaning of floors and furniture.

DR.T.V.RAO MD 50

IMPORTANCE OF STAFF

Staff should have well understood responsibilities.

Effective implementation of policy requires , motivated staff, with training,

Regular updating as new methods become available

DR.T.V.RAO MD 51

PROPHYLACTIC ANTIBIOTICS

Wide spread and haphazard use of antibiotics hasten emergence of antibiotic resistant bacteria.

Rational antibiotic prophylaxis plays an important role in infection control

Antibiotic policy limits the use of broad spectrum agents, and is important in both prophylaxis and treatment.

DR.T.V.RAO MD 52

Different activities

within the hospital

require different

degrees of protection to

staff and patients.

In operation theatre the

wearing of sterile

gowns, gloves, head

gear and face mask

minimizes the shedding

of microorganisms.

PROTECTIVE CLOTHING

DR.T.V.RAO MD 53

BARRIER NURSING

Barrier nursing is highly

essential when soiling

of clothing is

anticipated, and dealing

with communicable

diseases, eg in EBOLA

and MARBURG

infections.

Doctorrao’s ‘e’ learning series Doctorrao’s ‘e’ learning series

DR.T.V.RAO MD 54

OTHER MEASURES

Gloves, face mask, and

goggles are indicated in

specific procedures.

The use of the above

should confirm to

international standards

and the staff should be

trained in their proper

use and disposal

DR.T.V.RAO MD 55

ISOLATION IN INFECTIOUS DISEASES

Practiced as a source isolation and to protect the susceptible or immunocompromised.

It needs a highly disciplined approach by all staff to ensure that none of the barriers to transmission are breached.

DR.T.V.RAO MD 56

CUBICLE ISOLATION

In which patient nursed alone in a room separated by door and corridor from other patients confers a substantial measures of protection.

Desirable to supply clean, filtered air is supplied to room with facilities for own toilet and washing facilities

DR.T.V.RAO MD 57

In some critical situations such as bone marrow transplant units, where air borne contamination with environmental fungal spores is a problem the efficiency of an air filtration may be increased and laminar airflow maintained as barrier around the patient

CRITICAL SITUATIONS

DR.T.V.RAO MD 58

TREXLER ISOLATOR

Stringent isolation such as a plastic tent or Trexler isolator, is required only for patients with highly contagious infections.

DR.T.V.RAO MD 59

HOSPITAL BUILDING AND DESIGN

Routine maintenance of the Hospital building is important, ensuring that surfaces wherever possible are smooth, impervious and easy to clean.

All constructions around the existsting Hospitals generate fungal spores and bacterial spores with have impact on specialized units serving immunocompromised patients

DR.T.V.RAO MD 60

LEGIONNAIRES’ DISEASE

PREVENTION

The risk of Legionnaires’ disease is reduced by regular flushing all outlets and installing water supplies that circulate below 200c for the cold and above 600c for the hot circuit

DR.T.V.RAO MD 61

EQUIPMENT All the equipment in

contact with patients need

decontamination and

sterilization

Heat is a preferred

method.

However heat sensitive to

the sterilized with

chemical and other newer

emerging methods

DR.T.V.RAO MD 62

All health care workers should screened for possible communicable diseases before employment, and offered immunization against Hepatitis B Viral infection.

An education on Universal Health Precautions is highly essential

PERSONNEL CARE OF HEALTH

CARE WORKERS

DR.T.V.RAO MD 63

NEEDLE STICK INJURIES

Who sustain needle

stick injuries from

potentially

contaminated sources

should have access to

advise and post

exposure

prophylaxis with

antiviral agents or

immunization.

DR.T.V.RAO MD 64

MONITORING OF THE ENVIRONMENT ?

Routine Microbiological monitoring of the environment is of little benefit,

But monitoring of the Air conditioning plants, and machinery used for disinfection and sterilization is essential

”

DR.T.V.RAO MD 65

Microbiological screening of staff and patients not undertaken routinely but it may be needed for specific purpose to detect carriers or MRSA and Hepatitis viruses in those performing some types of surgery or where transmission to patients has occurred.

SCREENING OF STAFF OR PATIENTS

DR.T.V.RAO MD 66

The detection and

identification of hospital

infection incidents or

outbreaks rely on the

laboratory data that

alert the infection

control team to unusual

cluster of infection,

called as ‘alert

organism’ system.

SURVEILLANCE AND ROLE OF

MICROBIOLOGY LABORATORIES

DR.T.V.RAO MD 67

SURVEILLANCE

Identification of MRSA & ESBL and timely information to clinicians will help the ongoing events in the Hospital warrant to track the events on source of outbreaks and action to control the similar situations in future

·

DR.T.V.RAO MD 68

Regular visits to wards are also important to record data on infected patients from whom no specimens have been received and to respond to problems as they occur.

Such visits will bring in grater human interaction with paramedical staff and deliver the practical teaching.

·

PRACTICAL TEACHING TO STAFF

DR.T.V.RAO MD 69

EFFICACY OF INFECTION CONTROL

The Following measures will certainly control the infections

1 Sterilization

2 Hand washing

3 Closed drainage systems for urinary catheters.

” 4 Intravenous catheter care

5 Peri operative antibiotic prophylaxis for contaminated wounds, and care of equipment used in respiratory therapy.

DR.T.V.RAO MD 70

MEASURES PROVED TO BE INEFFECTIVE

Chemical disinfection

of floors, walls, and

sinks

Routine

environmental

monitoring is losing

its concerns.

”

DR.T.V.RAO MD 71

Effective surveillance

and action by the

infection control team

have shown to reduce

infection rates.

One important role of

the team is to monitor

compliance and

practices known to be

effective.

WHAT IS MOST IMPORTANT

DR.T.V.RAO MD 72

With raising

economic costs in

running safe

hospitals eliminate

the many rituals or

less effective

practices that they

may even increase

the incidence or cost

of cross infection.

SAVING THE COSTS IN PREVENTION IF

INFECTIONS

DR.T.V.RAO MD 73

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Developing World

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DR.T.V.RAO MD 74