Transcript NOSOCOMIAL INFECTION

HEALTH CARE ASSOCIATED
INFECTIONS AND ITS CONTROL
Prof Victor Lim
International Medical
University
HEALTH CARE
ASSOCIATED INFECTION
• Definition
• Any infection acquired by patients or
members of staff while in a heath care setting
• Does not include infections which manifest in
a health care setting but acquired outside the
health care setting
• Includes infections acquired in a health care
setting but manifest after discharge
NOSOCOMIAL OR HOSPITAL
ACQUIRED INFECTION
• Old term
• Nosocomium = Hospital
• Increasing day-care and ambulatory
care in modern medical practice
• Chronic care facilities, nursing homes
• Confining definitions to hospitals only
may not reflect the true situation
• Infection control is also important in
non-hospital settings – hence healthcare associated infections
History of Nosocomial Infection
• Ignaz Semmelweis, (1840s)
demonstrated importance of hand
hygiene
• No progress for next century
• 1976, the Joint Commission on
Accreditation of Healthcare
Organizations - standards for infection
control
• Nosocomial infection still on the
increase - emerging infection
Reasons for Re-emergence
• Antibiotic resistance : HCAI
becoming more difficult to treat
• Increased numbers of vulnerable
patients
– progress in medical management
– increasing day-care & ambulatory care
• Failure of staff to comply with
infection control procedures
CAUSES OF HCAI
• Virtually all microorganisms can cause
nosocomial infections
• Viruses
• Bacteria
• Fungi
• Parasites
BACTERIA
• Bacteria
• Gram +
– Staphylococcus aureus
– Staphylococcus epidermidis
• Gram – Enterobacteriaceae
– Pseudomonas aeruginosa
– Acinetobacter baumanni
• Mycobacterium tuberculosis
NOSOCOMIAL PATHOGENS
• Viruses
– Blood borne
infections : HBV,
HCV, HIV
– Others: CMV, rubella,
varicella, SARS
• Fungi
– Candida
– Aspergillus
SOURCES OF INFECTION
Endogenous
source is the normal flora or
colonisers of skin and other
epithelial surfaces
Exogenous
other persons (cross-infection)
inanimate objects (fomites)
SPREAD OF INFECTONS
Air-borne
Skin scales, droplet nuclei
Contact
Direct
Hands & clothing
Droplet contact followed by autoinoculation
Clinical equipment
Indirect
Bedpans, bowls, jugs, etc
SPREAD OF INFECTONS
The hands are the most important
vehicle of transmission of
HCAI
National NI prevalence rates : Ministry
of Health and Teaching Hospitals
8
7
6
5
4
3
2
1
0
03/1
03/2
04/1
04/2
05/1
05/2
06/1
TYPES OF INFECTIONS
• Common infections
–Urinary tract infections
–Surgical wound infections
–Lower respiratory infections
–Traumatic wounds and burns
infections
–Primary bacteraemia
Types of infections : National
Surveillance
Percentage
100
90
80
70
60
50
40
30
20
10
0
OTHER
CS
SSI
BSI
PNE
UTI
03/1
03/2
04/1
04/2
05/1
06/1
COST OF INFECTIONS
United Kingdom
115 million pounds (1988)
United States of America
5 billion dollars (1987)
4.5 billion dollars (1995)
Malaysia
???
CONTROL OF HCAI
Hand hygiene is the
single most
important
measure for control
of nosocomial
infections
TYPES OF HAND HYGIENE
PROCEDURES
• Hand washing
– Hand washing is usually limited to hands and wrists
– Hands are washed for a minimum of 10 – 15 seconds with soap (plain
or antimicrobial) and water
– Transient micro-organisms are mechanically removed by rinsing.
• Hand antisepsis/decontamination
– Hand antisepsis removes or destroys transient micro-organisms and
confers a prolonged effect.
– Two ways:
» Wash hands and forearms with antimicrobial soap and water, for
15-30 seconds
» Decontaminate hands with a waterless, alcohol-based hand gel
or hand rub for 15-30 seconds. Appropriate for hands that are
not soiled with protein matter or fat.
TYPES OF HAND HYGIENE
PROCEDURES
• Surgical hand antisepsis
– Removes or destroys transient microorganisms and confers a prolonged effect.
– Hands and forearms are washed thoroughly
with an antiseptic soap for a minimum of 2-3
minutes.
– Hands are dried using a sterile towel.
– Required before performing invasive
procedures.
HAND WASHING TECHNIQUE
Source: World Health Organization. Regional Office for Western Pacific.
COMPOUNDS FOR
HAND ANTI-SEPSIS
• Recommended by WHO
–2%-4% chlorhexidine,
–5%-7.5% povidone iodine,
–1% triclosan, or
–70% alcoholic hand rubs.
WHO FIRST GLOBAL PATIENT
SAFETY CHALLENGE
• Clean care is safer care
• Alcohol-based hand rubs
must be available at the
point of care
• As effective as washing
with soap or antiseptic and
water
• More convenient and less
time consuming
THE SWISS EXPERIENCE
• A hand hygiene campaign was launched in January 2006,
in 116 hospitals nationwide.
• Alcohol-based hand rubs were available at the patient
bedside or carried by staff in their pocket.
• Overall hand hygiene compliance increased from 54% to
68% - a 25% boost in patient safety.
• Nurses’ compliance is 72%. Doctors’ compliance showed
an increase of 33% to an encouraging 60%
• Prevented 17,000 infections and saved CHF 60 million
nationwide.
• Hand rubbing now accounts for up to 97% of all hand
hygiene actions in Swiss hospitals
Source : WHO
OTHER MEASURES
• Practise aseptic techniques when performing
procedures
• Limit the duration of in-situ catheters (urinary
and intravascular) to shortest possible
• Meticulous care of lines, ventilator tubing,
catheters and wounds
OTHER MEASURES
• Isolation of infectious patients and immunocompromised patients
–
–
–
–
Source isolation
Protective isolation
Use of single rooms with bathroom attached
Use of positive or negative pressure rooms
• Protect yourself appropriately through good
practices and using personal protective
equipment (STANDARD PRECAUTIONS)
PRACTISE STANDARD
PRECAUTIONS
PROTECT YOURSELF
THROUGH IMMUNISATION
Immunisation
BCG
Hepatitis B
Tetanus
Rubella
Varicella
Influenza
CONCLUSIONS
• Preventing HCAI is a very important aspect of
patient safety
• All health care personnel must practise the
highest standards of infection control as
HCAIs
– Cause significant morbidity and mortality to patients and
health care staff
– Contribute to increasing prevalence of antibiotic
resistance
– Are difficult and expensive to manage
– Can result in medical litigation