Transcript Hospital Acquired infections – Dr. M.A

HOSPITAL-ACQUIRED INFECTIONS/
NOSOCOMIAL INFECTIONS

An infection contracted by a patient or staff member
while in a hospital or health care facility (and not
present or incubating on admission)

Hospital acquired infections are a common problem

Hundreds of millions of patients are affected by
health care-associated infections worldwide each
year, leading to significant mortality and financial
losses for health systems.

Of every 100 hospitalized patients at any given
time, 7 in developed and 10 in developing countries
will acquire at least one health care-associated
infection

1 in 10!
EPIDEMIOLOGY OF NOSOCOMIAL
INFECTIONS

Most common sites for nosocomial infections

Surgical incisions

Urinary tract (i.e., catheterrelated)

Lower respiratory tract

Bloodstream (i.e., catheter-related)
Surgical incisions
Urinary tract (i.e., catheter-related)
Lower respiratory tract
Ventilator associated pneumonia
Bloodstream (i.e., catheter-related)
The CVC- is one of the most
commonly used catheters in
medicine
The CVC is typically placed
through a central vein such as
the IJ, Subclavian or femoral
These serve as
direct line for
microbial
bloodstream
invasion
Bloodstream (i.e., catheter-related)
stream (i.e., catheter-related)
COMMON MICROORGANISMS

Gram-positive cocci (Staphylococcus
aureas [MRSA], enterococci
[vancomycin-resistant]),

Gram-negative bacilli (Escherichia coli,
P. aeruginosa, Enterobacter spp., and Klebsiella
pneumoniae
NOSOCOMIAL TRANSMISSION OF COMMUNITY
ACQUIRED, MULTIDRUG-RESISTANT ORGANISMS




M. tuberculosis
Salmonella spp.
Shigella spp.
V. cholerae
ROOT CAUSES OF NOSOCOMIAL
INFECTIONS




Lack of training in basic Infection Control
Lack of an IC infrastructure and poor IC
practices (procedures)
Inadequate facilities and techniques for hand
hygiene
Lack of isolation precautions and procedures

Use of advanced and complex treatments
without adequate training and supporting
infrastructure, including—







Invasive devices and procedures
Complex surgical procedures
Interventional obstetric practices
Intravenous catheters, fluids, and medications
Urinary catheters
Mechanical ventilators
Inadequate sterilization and disinfection
practices and inadequate cleaning of
hospital
CORE STRATEGIES TO REDUCE
NOSOCOMIAL INFECTIONS—HAND HYGIENE
To ensure appropriate hand washing techniques—




Provide sinks, clean water, and soap at convenient
locations
Where sinks, clean water, and hand washing supplies
are unavailable, use alcohol-based products which
are inexpensive, produced locally, convenient, and
effective for hand hygiene.
Monitor compliance
Use gloves when necessary
ISOLATION
AND
STANDARD PRECAUTIONS

Whenever possible, avoid crowding wards.

Implement specific policies and procedures for patients with
communicable diseases:

Private rooms and wards for patients with specific diseases

Visitation policies

Hand washing and use of gloves

Gowns, when appropriate

Masks, eye protection, gowns

Precautions with sharp instruments and needles
ENSURING A CLEAN ENVIRONMENT

Establish policies and procedures to prevent food and water
contamination

Establish a regular schedule of hospital cleaning with appropriate
disinfectants in, for example, wards, operating theaters, and laundry

Dispose of medical waste safely

Needles and syringes should be incinerated

Other infected waste can be incinerated or autoclaved for landfill
disposal

Bag and isolate soiled linen from normal hospital traffic
CLEANING, DISINFECTION, AND
STERILIZATION OF INSTRUMENTS
SUPPLIES
AND

Written policies and procedures are needed

All objects to be disinfected or sterilized should first be thoroughly cleaned

Use stream sterilization whenever possible

Quality control in reprocessing is essential

Monitor and record sterilization parameters (i.e., time, temperature, pressure)

Biological indicators should be used to ensure sterilization

Chemical indicators are necessary for chemical sterilization

Sterilized items must be stored in enclosed clean areas

Items or devices that are manufactured for single use should not be reprocessed
(e.g., disposable syringes and needles)
STANDARD PRECAUTIONS
 Masks,

eye protection, face shield:
Wear during activities likely to generate splashes
or sprays
 Gowns
Protect skin and soiling of clothing
 Wear during activities likely to generate splashes
or sprays

 Sharps
Avoid recapping of needles
 Avoid removing needles from syringes by hand
 Place used sharps in puncture –resistant
containers

AIRBORNE PRECAUTIONS
Designed to prevent airborne transmission of
droplet nuclei or dust particles containing
infectious agents
 For patient with documented or suspected:

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
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Measles
Tuberculosis (primary or lanryngeal)
Varicella (airborne + contact)
Zoster (disseminated or immunocompromised
patient; (airborne and contact)
SARS (Contact+airborne)
DROPLET PRECAUTIONS

Designed to prevent droplet (larger particle)
transmission of infectious agents when the patient
talks, coughs, or sneezes
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For documented or suspected:

Adenovirus (droplet+contact)

Group A step pharyngitis, pneumonia, scarler fever (in
infants, young children)

H. Influenza meningitis, epiglottitis

Infleunza, Mumps, Rubella

Meningococcal infections
SUMMARY

IC procedures are vital to preventing nosocomial infections and for controlling
hospital costs.


Simple, inexpensive strategies can prevent many infections.

Hand washing and use of appropriate antiseptics and disinfectants

Monitoring IV and injection preparation and administration
Policy for Antibiotics

Guidelines for treatment and surgical prophylaxis
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Selection of appropriate antimicrobials for the formulary
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Antimicrobial use reviews

Infection Control Committees or programs,
when functioning effectively, will

Reduce the spread of infectious diseases
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Decrease morbidity and mortality due to nosocomial
infections
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Maintain employee health and morale
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Decrease the incidence of AMR
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Decrease health care costs
 Hand
Hygiene is the single most
effective intervention to reduce
the cross transmission of
nosocomial infections
RECENT EXAMPLE OF HAI

Outbreak of multiresistant Klebsiella
pneumoniae
in PBU of DGH Nuwara Eliya
WHY? HOW??
Poor hand hygiene?
 Contaminated infusates?
 Lack of general cleanliness?

REGULAR VISITS TO PBU
IS OUR HAND-RUB GIVES EXPECTED
RESULTS?
CHECK THE IN-HOUSE HAND-RUB!
Formulation I
 To produce final concentrations of ethanol
80% v/v, glycerol 1.45% v/v, hydrogen peroxide
(H2O2) 0.125% v/v.
 Pour into a 1000 ml graduated flask:
 ethanol 96% v/v, 833.3 ml
 H2O2 3%, 41.7 ml
 glycerol 98%,14.5 ml

Formulation II
 To produce final concentrations of isopropyl
alcohol 75% v/v, glycerol 1.45% v/v, hydrogen
peroxide 0.125% v/v:
 Pour into a 1000 ml graduated flask:
 isopropyl alcohol (with a purity of 99.8%), 751.5
ml
 H2O2 3%, 41.7 ml
 glycerol 98%, 14.5 ml

TO STOP OR CONTROL HAI

Hand hygiene – Properly done “hand hygiene”