Transcript Infection control in Healthcare Setting

‫به نام خدا‬
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Role of Microbiology laboratory
In Prevention of
Healthcare-associated infections
Sina Mobasherizadeh
PhD Candidate of Bacteriology
IUMS
Healthcare-associated infections, or HAIs, are infections that people
acquire while they are receiving treatment for another condition in a
healthcare setting.
HAIs can be acquired anywhere healthcare is delivered, including:
inpatient acute care hospitals, outpatient settings such as ambulatory
surgical centers and end-stage renal disease facilities, and long-term
care facilities such as nursing homes and rehabilitation centers.
HAIs may be caused by any infectious agent, including bacteria, fungi,
and viruses, as well as other less common types of pathogens.
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These infections are associated with a variety of risk factors,
including:
Use of indwelling medical devices such as:
 bloodstream, endotracheal, and urinary catheters.

Surgical procedures, Injections,
•
Contamination of the healthcare environment
 Transmission of communicable diseases between patients and
healthcare workers

Overuse or improper use of antibiotics.
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importance of the Problem
 HAIs are a significant cause of morbidity and mortality.

At any given time, about 1 in every 20 inpatients has an infection
related to hospital care.
 These infections cost the U.S. healthcare system billions of dollars
 Each year and lead to the loss of tens of thousands of lives.
 In addition, HAIs can have devastating emotional, financial and
medical consequences.
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Transmission of Nosocomial Infections
Healthcare worker
to patient
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Patient to
healthcare worker
Patient to patient
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A majority of hospital-acquired HAIs include:
 Urinary tract infections
 Surgical site infections
 Bloodstream infections
 Pneumonia
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Microbiologist as Member of Infection Control
Committee (ICC), Infection Control Team (ICT) and
Antibiotic Committee
Role of Laboratories
“Provide information for decision making
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Having microbiology laboratory as a part of the hospital diagnostic
laboratories, is a huge advantage for HAI prevention and control.
Microbiology laboratory has two main functions in the hospital:
one is diagnosis of infection in individual patient, directly related
to the patient care and the other is support to the HAI prevention
and control.
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The role in HAI prevention
O 1. Rapid Communication
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2. Accurate speciation and typing of isolated pathogen
To be useful for epidemiological studies of HAI,
isolated bacterial strains should be identified to the
species level.
There are two groups of typing methods:
a) phenotyping
b) genotyping
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3. Participation in outbreak management
The early isolation of a new or unusual microorganism
enables the ICP to take appropriate measures to stop it from
spreading at the very beginning.
Laboratory staff may also report clustering of infections (two
related isolates in different patients in the same time
frame), which then enables ICP to go and check these cases.
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4. Participation in HAI surveillance
Surveillance of HAI is an important task of a well
organized infection control.
in alert or multi-drug resistant (MDR) organisms
surveillance the role of microbiology laboratory is crucial.
The most important ‘alert’ microorganisms are:
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•Methicillin-resistant Staphylococcus aureus (MRSA)
• Vancomycin-intermediate S. aureus (VISA)
• Vancomycin-resistant enterococci (VRE)
• MDR Pseudomonas aeruginosa
• MDR Acinetobacter baumannii
• MDR Mycobacterium tuberculosis
• ESBL enterobacteria
• Clostridium difficile
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C. difficile infections are at an all-time high

C. difficile infections are linked to 14,000 deaths in the US each year.
O
Deaths related to C. difficile increased 400% between 2000 and 2007, due in part to a
stronger germ strain.
O
Most C. difficile infections are connected with receiving medical care.
O
Almost half of infections occur in people younger than 65, but more than 90% of deaths
occur in people 65 and older.
O
Infection risk generally increases with age; children are at lower risk.
O
C. difficile germs move with patients from one health care facility to another, infecting
other patients.
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5. Participation in resistance surveillance
The surveillance of bacterial resistance to antimicrobial
agents is very important task of microbiological laboratory.
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Antimicrobial Resistance Surveillance is dependent on
all of the following:
O Obtaining appropriate specimens from the infected individual
O Successful isolation of the causative organisms
O Accurate determination of antimicrobial resistance
O Data collection, collation and analysis
O Dissemination of appropriate information for Action
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WHONET 5 Software
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WHONET is a free software developed by the WHO Collaborating
Centre for Surveillance of Antimicrobial Resistance for laboratorybased surveillance of
infectious diseases and antimicrobial
resistance.
The principal goals of the software are:
• to enhance local use of laboratory data; and
• to promote national and international collaboration through the
exchange of data.
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6. Education of HAI prevention personnel
and other healthcare workers
Microbiologist acts also as an educator for infection control
personnel,
first about characteristics of microorganisms that are important for
epidemiology of infections,
Then about normal flora, difference between contamination,
colonization and infection with specific organisms,
furthermore about interpretation of microbiological reports and
charts.
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Hand disinfection
Samples taken from hands
a)
ccontaminated
hands
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b)
after washing
hands
Quelle: Händehygiene in der Medizin, 1996
c)
after hand
disinfection
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