Hospital acquired infections
Download as PPTX, PDF408 likes346,280 views
The document discusses hospital acquired infections, also known as nosocomial infections. It defines nosocomial infections as infections acquired during or after hospitalization. It discusses the epidemiological interaction between host factors, infectious agents, and the hospital environment. It also summarizes common bacterial, viral, and fungal agents that cause nosocomial infections and how they are transmitted. Prevention and control methods like isolation precautions, hand hygiene, and surveillance programs are also outlined.
Hospital acquired infections
- 1. Aarti Sareen MSPT Honours I Roll No. 8 HOSPITAL ACQUIRED INFECTIONS
- 2. Hospital acquired infection is also called Nosocomial infection or Healthcare-associated infections. "nosus" = disease "komeion" = to take care of Nosocomial infections can be defined as infection acquired by the person in the hospital, manifestation of which may occur during hospitalization or after discharge from hospital. The person may be a patient, members of the hospital staff and/ or visitors.
- 4. EPIDEMIOLOGICAL INTERACTION HOST FACTORS Suppresed immune system due to Age, Poor nutritional status, severity of underlying disease, complicated diagnostic & therapeutic procedure,therapeutic, NCI THE ENVIRNOMNET Everything that surrounds the patient THE AGENT in the hospital is his environment. Varieties of organisms Other patients Institutional and human Hospital staff and visitors Eatables Reservoirs & their virulence Dust and other contaminated articles
- 5. SOURCE OF INFECTION Exogenous/indirect Endogenous/direct: Caused by organisms acquiring by exposure to hospital personnel, medical Caused by the devices or hospital environment, cross- infection from medical personnel organisms that are • hospital environment- inanimate objects present as part of – air normal flora of the – dust – IV fluids & catheters patient – washbowls – bedpans – endoscopes – ventilators & respiratory equipment – water, disinfectants etc
- 7. The Inanimate Environment Can Facilitate Transmission ~ Contaminated surfaces increase cross-transmission ~
- 9. Nosocomial Infections: Changing Microbiology • Mid-1980’s • Mid-1990’s – Enterobacteriaceae – Decline in Enterobacteriaceae – S. aureus – Increase in gram- – P. aeruginosa positive cocci – Emergence of fungi – Recognition of viruses
- 10. All microorganisms can cause nosocomial infections Viruses Bacteria Fungi Parasites
- 11. BACTERIA Gram +ve Staphylococcus aureus Staphylococcus epidermidis Gram -ve Enterobacteriaceae Pseudomonas aeruginosa Acinetobacter baumanni Mycobacterium tuberculosis
- 12. COMMON BACTERIAL AGENTS Pseudomonas (9%) aeruginosa Enterococcus (10%) Coag-neg staphylococcl (11%) E-coli (12%) Staphylococcus aureus (13%) Other (45%)
- 13. Viruses ◦ Blood borne infections : HBV, HCV, HIV ◦ Others: rubella, varicella, SARS Fungi ◦ Candida ◦ Aspergillus
- 14. TYPES OF INFECTIONS – Urinary tract infections (UTI) – Surgical wound infections (SWI) – Lower respiratory infections – Traumatic wounds and burns infections – Primary bacteraemia – Gastrointestinal tract – Central nervous system
- 15. Major Types of Nosocomial Infections 35 30 25 UTI 20 Pneumonia 15 SWI Bloodstream 10 Other 5 0 Richards, MJ. 1999. Overall ICU Crit Care Med 27; 887.
- 16. Mode of trasmission Contact/hand borne (most common) Aerial route or air borne Oral route Parenteral route Vector borne
- 17. 1. Contact (most common) Direct (physical contact) – Hands & clothing – Droplet contact followed by autoinoculation – Clinical equipment Indirect via contaminated articles – Bedpans, – bowls, jugs, – Instruments like needles, – dressings, – contaminated gloves,etc.
- 18. 2. Airborne Transmission – Droplet respiratory secretions on surfaces – Inhalation of infectious particles e.g. (TB, Varicella) 3. Oral route 4. Parenteral route 5. Vector borne: through mosquitoes, flies, rats
- 20. The hands are the most important vehicle of transmission of HCAI
- 21. Why Don’t Staff Wash their Hands (Compliance estimated at less than 50%)
- 22. 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)
- 23. Hand Hygiene Techniques 1. Alcohol hand rub 2. Routine hand wash 10-15 seconds 3. Aseptic procedures 1 minute 4. Surgical wash 3-5 minutes
- 24. Routine Hand Wash Repeat procedures until hands are clean
- 25. Areas Most Frequently Missed HAHS © 1999
- 26. Hand Care • Nails • Rings • Hand creams • Cuts & abrasions • “Chapping” • Skin Problems
- 27. Hand hygiene is the simplest, most effective measure for preventing hospital-acquired infections.
- 28. Surveillance
- 29. Why surveillance? • NCI cause of morbidity and mortality • One third may be preventable • Surveillance = key factor – an infection control measure – overview of the burden and distribution of NCI – allocate preventive resources • Surveillance is cost-efficient!!
- 30. Objectives • Reducing infection rates • Establishing endemic baseline rates • Identifying outbreaks • Identifying risk factors • Persuading medical personnel • Evaluate control measures • Satisfying regulators • Document quality of care • Compare hospitals’ NCI rates
- 31. The surveillance loop Health care Surveillance centre system Reporting Event Data interpretation Analysis, Action Information Feedback, recommendations
- 32. Considerations when creating a surveillance system • Goal of the surveillance system (why) • Engage the stakeholders (who) • Surveillance method (what, how, when) – definition – what to collect – how to collect (operation of system) • Available resources
- 33. Who • All hospitals? • All departments? • All specialties? • Other health institutions?
- 34. Stakeholders Central adm. Local ….. adm. Public Health ICP instituteI It- Directorat Surveillance of dep. surgical site infections Ministry Surgical Of health wards Service Surgical dep. ward. 2 Lab Patients
- 36. Control of NCI
- 37. Goals for infection control and hospital epidemiology There are three principal goals for hospital infection control and prevention programs: 1. Protect the patients 2. Protect the health care workers, visitors, and others in the healthcare environment. 3. Accomplish the previous two goals in a cost effective and cost efficient manner, whenever possible. .
- 38. To control the nosocomial infection we need to consider the chain of infection and the transmission of an infectious agent
- 39. Prevention & control of nosocomial infections – observance of aseptic technique – frequent hand washing especially between patients – careful handling, cleaning, and disinfection of fomites – where possible use of single-use disposable items – patient isolation – avoidance where possible of medical procedures that can lead with high probability to nosocomial infection (urinary catheter)
- 40. Prevention & control of nosocomial infections (cont.) – Various institutional methods such as air filtration within the hospital – Appropriate isolation precautions to protect patients, visitors, and HCWs. – Surveillance for common infections, monitoring of high risk patients, and hospital area to identify outbreaks, document incidence and prevalence rate of specific infections and set goal for improvement.
- 41. Uttermost care should be taken in following services: • House keeping • Dietary services • Linen and laundry • Central sterile supply department • Nursing care • Waste disposal • Antibiotic policy • Hygiene and sanitation
- 42. Isolation & barrier precautions Decontamination of equipment Prudent use of antibiotics Hand washing Decontamination of environment The 5 pillars of infection control
- 44. Infection control Committee (ICC): 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.
- 45. Infection Control Team Infection Control Doctor (ICD) Infection Control Nurse (ICN)
- 46. Role of infection control teams • Education and training • Development and dissemination of infection control policy • Monitoring and audit of hygiene • Clinical audit