1. Define infection and infection control.

2. Identify the impacts of Nosocomial infections.

3. Recognize the common sits and criteria of Nosocomial
infections.
4. Describe the factors influencing Nosocomial infections.
5. Discuss the hospital infection control program.
6. Identify the component and responsibility of infection
control program.
! Patient may acquire infection before admission to the
hospital = Community acquired infection.

! Patient
may get infected inside the hospital =
Nosocomial infection.

! It includes infections
!not present nor incubating at admission,
!infections that appear more than 48 hours after admission,
!those acquired in the hospital but appear after discharge
!also occupational infections among staff.
} Definition: Injurious contamination of body or parts of the body by
bacteria, viruses, fungi, protozoa and rickettsia or by the toxin that
they may produce.
Infection may be local or generalized and spread throughout the
body.
Once the infectious agent enters the host it begins to proliferate and
reacts with the defense mechanisms of the body producing infection
symptoms and signs: pain, swelling, redness, functional disorders, rise
in temperature and pulse rate and leukocytosis.
! Nosocomial infections occur worldwide.
! The incidence is about 5-8% of hospitalized patients,
1/3 of which is preventable.
! The highest frequencies are in East Mediterranean
and South-East Asia.
! A high frequency of N.I. is evidence of poor quality
health service delivered.
" They lead to functional disability and emotional stress
to the patient.
" They lead to disabling conditions that reduce the
quality of life.
" They are one of the leading causes of death.
" The increased economic costs are high: Increased
length of hospital stay (SSI - 8.2 days), extra
investigations, extra use of drugs and extra health
care by doctors and nurses.
!Organisms causing N.I. can be
transmitted to the community through
discharged patients, staff and visitors. If
organisms are multi-resistant they may
cause significant disease in the
community.
Ü Thecost varies according to the type and severity of
these infections.

Ü An estimated 1 to 4 extra days for a urinary tract

infection, 7 – 8 days for a surgical site infection, 7 –
21 days for a blood stream infection, and 7 – 30 days
for pneumonia.

Ü TheCDC has recently reported that US $5 billion are

added to US health costs every year as a result of NI.
ª Urinary tract infection: most common type of N I (30-
40% of reported cases), associated with an indwelling
‫ اﻟﺛﺎﺑﺗﺔ‬urinary catheter or instrumentation.

ª Lowerrespiratory and surgical wound infections are

the next (each about 15%).

ª Less frequent include bacteraemia (5%), intravenous

site infection, gastrointestinal tract and skin infections.
Surgical site infection Any purulent discharge, abscess or
spreading cellulitis at the surgical
site during the month after operation
Urinary infection Positive urine culture (1 or 2
species) with at least 100,000
bacteria/ml, with or without clinical
symptoms
Respiratory infection Respiratory symptoms with at least
2 signs: cough; purulent sputum;
new infiltrate on chest, appearing
during hospitalization
Vascular catheter Inflammation, lymphangitis or
infection purulent discharge at the insertion
site
Septicaemia Fever or rigors and at least one
positive blood culture
! The microbial agent

! Patient susceptibility

! Environmental factors
î Many sick people are treated in a closed area;
micro-organisms, frequent contact between carriers
& susceptible, contaminated waste, equipment and
supplies to be handled.

î Developing of clinical disease depends on organism’s

virulence, infective dose and patient resistance.
(1)-Bacteria are the most common pathogens.

1. Commensal bacteria: found in normal flora of healthy

humans, prevent pathogenic bacterial colonization eg skin,
colon, vagina

2. Pathogenic bacteria: have great virulence and cause

infection as:
v Anaerobic gram +ve rods e.g Clostridium causing
gangrene.
v Gram +ve bacteria: Staph. aureus found on skin & nose,
Beta-hemolytic Strep.
v Gram -ve bacteria as E.coli, Proteus, Klebsiella, legionella
species.
(2)- Viruses: HIV, HBV, HCV can be also transmitted
through blood & B F (transfusion, injections, dialysis),
respiratory syncytial virus, rota virus, ebola, infleunza, herpes
simplex viruses.

(3)- Parasites & Fungi: e.g. Giardia lamblia is

easily transmitted between adults or children, Aspergillus sp.

affecting immunocompromised, Scabies an ecto-parasite causing
outbreaks.
# Age: infants and old age have decreased resistance
to infection.

# Immune status: Patients with chronic diseases as

malignancy, leukaemia, diabetes mellitus, renal failure
or AIDS have increased susceptibility to infection.
# Immunosuppressive drugs or irradiation
Ø Healthcare settings are environment where both
infected persons and persons at high risk of infection
congregate.
Ø Crowded conditions within hospital, frequent transfers
of patients between units.
Ø Microbial flora may contaminate objects, devices and
materials which subsequently contact susceptible body
sites of patients.
} Where do nosocomial infection come from?
ü Endogenous infection: When normal patient flora change
to pathogenic bacteria because of change of normal habitat,
damage of skin and inappropriate antibiotic use. About
50% of N.I. are caused by this way.
ü Exogenous cross-infection: Mainly through hands of
healthcare workers, visitors, patients.
$ Exogenous environmental infections: several types of
micro-organisms survive well in the hospital environment
(hospital flora):
* In water, damp areas ‫اﻟﻤﻨﺎطﻖ اﻟﺮطﺒﺔ‬and occasionally in
sterile products or disinfectants eg pseudomonas,
Acinetobacter, Mycobacterium.
* On items such as linen, equipment and supplies
* In food.
* In fine dust and droplet nuclei

$ Some procedures that save life may increase risk of

infection e.g urinary catheters, I.V.L (intravenous lidocaine,
analgesic) inhalation therapy, surgery.
$ Inappropriate use of antibiotics.
þ Prevention of nosocomial infection is the responsibility
of all individuals and services provided by healthcare
setting.
þ To practice good asepsis, one should always know: what
is dirty, what is clean, what is sterile and keep them
separate.
þ Hospital policies & procedures are applied to prevent
spread of infection in hospital.
} A comprehensive, effective and supported program is
essential for reducing infection risk and increasing
hospital safety.

} It should include surveillance, preventive activities and

staff training.
I. National program developed by Ministry of Health: to
support hospital programs. It sets national objectives, develops
and updates guidelines recommended for health care.

II. Hospital programs including:

1) major preventive efforts; keeping in mind patients and staff.

2) It must be supported by senior management and provided
with sufficient resources.
3) It must develop a yearly work plan to assess and promote all
good health care activities.
 Hospital Program

Infection Conrtol Team Infection control committee Infection control manual

} The optimal structure varies with hospitals types, needs
and resources.
} Hospital can appoint epidemiologist or infectious
disease specialist, microbiologist to work as
infection control physician.
} Infection control nurse who is interested and has
experience in infection control issues.
% Team should have authority to manage an effective control
program.

% Teamshould have a direct reporting with senior

administration.

% Infection
control team members are responsible for day-
to-day functions of IC and preparing the yearly work plan.

% They should be expert and creative in their job.

!Itis a multidisciplinary committee responsible for
monitoring program policies implementation and
recommend corrective actions.

!Itincludes representatives from different concerned

hospital departments & management. They meet
bimonthly.

!Itestablishes standards for patient care, it reviews and

assesses IC reports and identifies areas of intervention.
"Every Hospital should have a nosocomial infection
prevention manual compiling recommended
instructions and practices for patient care.

"This manual should be developed and updated in a

timely manner by the infection control team.

"Itis to be reviewed and accepted by infection

control committee.
& Role of every hospital department and service units
must be identified, documented as manuals kept in
accessible place.

& Job description of every hospital staff; defining details

of his duties must be discussed before employment.
Infection control precautions should be part of the
routine work and stressed for that.
 Program Components

Surveillance Preventive Activities Staff Training

} Nosocomial infection rate in a hospital is an indicator of
quality and safety of care.

} Surveillance to monitor this rate is essential to identify

problems and evaluate control activities

} The ultimate aim is the reduction of infection rate and their

costs.

} The term surveillance implies that observational data are

regularly analyzed.
} 1-Standard precautions.
} 2-Isolation precautions.

} Will be discussed in details in L3 and L4.

}
 B. Environmental control
(Preventive activities)

1. Including physical facility plans must meet quality and infection

control measures. Patient equipment positioning and installation,
traffic flow..‫ وﺗﺪﻓﻖ ﺣﺮﻛﺔ اﻟﻤﺮور‬، ‫ﺗﺤﺪﯾﺪ ﻣﻮاﻗﻊ ﻣﻌﺪات اﻟﻤﺮﺿﻰ وﺗﺮﻛﯿﺒﮭﺎ‬

2. Cleaning of hospital environment and dis-infection according to

policies.

3. Proper air ventilation.

4. Water pipes examination, check its quality.

5. Proper waste collection and disposal.

6. Cleaning and dis-infection of equipment.

7. Proper linen collection, cleaning, distribution

8. Food : ensure quality and safety.

9. Sterilization: Central sterilization department serving all

hospital departments compiling with infection control
precautions.
 C. Staff health promotion and education

1. HCW are at risk of acquiring infection, they can also

transmit infection to patients and other employee.

2. Employee health history must be reviewed,

immunizations recommendations to be considered.

3. Release from work if sick, occupational injury must

be notified.

4. Continuous education to improve practice, better

performance of new techniques.
} Evaluation of Infection Prevention and Control
Programmes (IPC), and Assessment Tools for
IPC-Programmes at MOH-Health Facilities in
Saudi Arabia
} https://www.kfshrc.edu.sa/store/media/1er.
pdf
} INFECTION CONTROL MANUAL KSA.