HOSPITAL ACQUIRED (NOSOCOMIAL) INFECTION
Mahboob Ali Khan MHA CPHQ USA Harvard
DEFINITION:
ANY INFECTION ACQUIRED BY A PATIENT IN HOSPITAL.
SOME STATISTICS:
• Affects approx. 10% of all in-patients • (KFHUrate the last 5 years 1.14%)• delays discharge • HAI costs 2times >no infection• direct cause deaths
Socio-economic burden of HAI
SOURCES:
1.Patients own flora - Endogenous (50%) Auto-Infection ( Greatest source of potential danger)2.Environment - Exogenous(15%) (Air-5%; Instruments-10%) 3.Another Patient/Staff - Cross Infection (35%)
Classification of surgical procedures
Cleanno entry into GI/GU/Resp tractlow riskinfection usually exogenous
Clean contaminatedno significant spillagee.g. cholecystectomy
infection rates 5-10 %
Contaminated Significant spillage of bacteria expected Infection rate 18-20%
DirtyPerforated viscus drainage of abscess Infection rate often >30%
IMPORTANT CROSS-INFECTION ORGANISMS
METHICILLIN RESISTANT STAPH AUREUS (MRSA)
Resistant to Flucoxacillin and usually others
May cause - Wound infection Bacteraemia Skin/soft tissue infection U.T.I. Pneumonia etc.
Colonisation common:
Nose Axilla Perineum Wounds/Lesions
Spread By:
Hands Fomites Aerosols Becoming more common in the Community
Control:
Eradication of carriage Barrier nursing Screening of other patients Staff
TUBERCULOSIS Open pulmonary TB (Sputum smear positive for AFB)
VIRAL INFECTIONS
Chicken Pox (Hepatitis B HIV)
RESISTANT GRAM NEGATIVE ORGANISMS
Resistance to multiple antibiotics
Organisms:E .coli Proteus Enterobacter Acinetobacter Pseudomonas aeruginosa
Cause: Bacteraemia U.T.I. Pneumonia Wound infection
Control: Antibiotic Policy Control of Infection Guidelines Prevention of Cross Infection especially on high risk areas
SURVEILLANCE
Important means of monitoring HAI Early detection of trends outbreaks 1. Laboratory Based Microbiology Laboratory lists +ve organisms ICN reviews ‘Alert organisms’ reported 2. Ward Based Ward staff monitor patientsICN reviews ICN visits wards
H.A.I. IS INCREASING: compromised patients ward and inter-hospital transfers antibiotic resistance (MRSA, resistant Gram negatives) increasing workload
staff pressures lack of facilities ? lack of concern
HAI is inevitable but some is preventable (irreducible minimum)
realistically reducible by 10-30%
Many Personnel Don’t Realize When
They Have Germs on Their Hands• Healthcare workers can get 100s to 1000s of
bacteria on their hands by doing simple tasks like: – pulling patients up in bed
– taking a blood pressure or pulse
– touching a patient’s hand
– rolling patients over in bed
– touching the patient’s gown or bed sheets
– touching equipment like bedside rails, overbed tables, IV pumps
Casewell MW et al. Br Med J 1977;2:1315Ojajarvi J J Hyg 1980;85:193
GENERAL PRINCIPLES
Good general ward hygiene: - No overcrowding - Good ventilation - Regular removal of dust - Wound dressing early in day - Disposable equipment
HAND WASHING
most important - Before and after patient contact
before invasive procedures
Why
Don’t Staff Wash their Hands
(Compliance estimated at less than 50%)
Why Not?• Skin irritation• Inaccessible hand washing facilities• Wearing gloves• Too busy• Lack of appropriate staff• Being a physician
(“Improving Compliance with Hand Hygiene in Hospitals” Didier Pittet. Infection Control and Hospital Epidemiology. Vol. 21 No. 6 Page 381)
Why Not?• Working in high-risk areas
• Lack of hand hygiene promotion
• Lack of role model
• Lack of institutional priority
• Lack of sanction of non-compliers
Successful Promotion • Education• Routine observation & feedback• Engineering controls
– Location of hand basins– Possible, easy & convenient– Alcohol-based hand rubs available
• Patient education(Improving Compliance with Hand Hygiene in Hospitals. Didier Pittet. Infection Control and Hospital Epidemiology. Vol. 21 No. 6 Page 381)
Successful Promotion • Reminders in the workplace
• Promote and facilitate skin care
• Avoid understaffing and excessive workload; Nursing shortages have caused
Hand Hygiene
Easy, timely access to both hand hygiene and skin protection is necessary for satisfactory hand hygiene.
A study by Pittet showed a 20% increase in compliance by using feedback and encouraging the use of alcohol hand rubs
Hand Hygiene Techniques1. Alcohol hand rub
2. Routine hand wash 10-15 seconds
3. Aseptic procedures 1 minute
4. Surgical wash 3-5 minutes
Repeat procedures until hands are clean
Routine Hand Wash
Alcohol Hand Rubs
• Require less time
• Can be strategically placed
• Readily accessible
• Multiple sites
• All patient care areas
Alcohol Hand Rubs• Acts faster
• Excellent bactericidal activity
• Less irritating (??)
• Sustained improvement
Alcohol Hand RubsChoose agent carefully:
– Adequate antimicrobial efficacy
– Compatibility with other hand hygiene products
Visible soiling
Hands that are visibly soiled or potentially grossly contaminated with dirt or organic material MUST by washed with liquid soap and water
Areas Most Frequently Missed
HAHS © 1999
Hand Care• Nails
• Rings
• Hand creams
• Cuts & abrasions
• “Chapping”
• Skin Problems
Hand hygiene is the simplest, most effective measure for preventing
hospital-acquired infections.
PREVENTING CROSS INFECTION
If known or suspected on admission to hospital, or detected following admission:
- Isolation (barrier precautions) - Inform Infection Control team - Treatment - if appropriate - Regular surveillance
Any Questions???
• Thank you for not asking!!!
tHanK YoU fOr yoUr cOopeRatiOn and UnTiriNg sUPpoRt