001 basic - epidemiology& principles prime 2015

HEALTHCARE-ASSOCIATED HEALTHCARE-ASSOCIATED INFECTIONS: INFECTIONS:

Epidemiology and PrinciplesEpidemiology and Principles

INFECTIONINFECTION““the state or condition in which the the state or condition in which the body or part of the body is invaded body or part of the body is invaded

by a pathogenic agent (bacteria, by a pathogenic agent (bacteria, virus, parasites etc.) which under virus, parasites etc.) which under

favorable conditions multiplies and favorable conditions multiplies and produces effects which are produces effects which are

injurious...”injurious...”

Nosocomial InfectionNosocomial Infection

• ““hospital acquired “ hospital acquired “

• ““hospital-associated”hospital-associated”

• ““healthcare-associated”healthcare-associated”

• infections that are caused infections that are caused by microorganisms and by microorganisms and acquired within the acquired within the healthcare facilityhealthcare facility

Nosocomial InfectionNosocomial Infection

Infection acquired 48 hoursInfection acquired 48 hours

after admission to hospitalafter admission to hospital• should not be present on

admission• acquired while in the

healthcare facility• May manifest after

discharge

Types of Nosocomial Types of Nosocomial InfectionInfection

UrinaryUrinary RespiratoryRespiratory GastrointestinalGastrointestinal Blood streamBlood stream Skin, Wound, BurnSkin, Wound, Burn Surgical wound infectionSurgical wound infection OthersOthers

Healthcare-associated InfectionsHealthcare-associated Infections

PREVALENCE / PREVALENCE / INCIDENCEINCIDENCE

< 5% - > 50%< 5% - > 50%

Infection ControlRate in Philippine

Hospitals

Pooled Cumulative Incidence Density Of HCAI And Device-associated Infection In Adult ICU Patients In

High-, Middle- And Low-income Countries

Burden of Endemic Health Care-Associated Infections, A systematic review of the literature, WHO Report 2011

2.5x higher

Comparison of Local and International HCAI Data

SHIP NHSN INICC

FC-UTI 1.91 3.4 6.1

CL Associated Bloodstream Infection

2.76 1.5 7.4

Ventilator Associated Pneumonia

11.2 2.2 14.7

SHIP - Surveillance of Hospital Acquired Infection in the Philippines, Philippine Hospital Infection Control Society, Inc.NHSN - Hational Healthcare Safety Network, CDC, USAINICC - International Nosocomial Infection Control Consortium, Dr David Rosenthal

Hospital Wide Surveillance Component Hospital Wide Surveillance Component and Medians of Hospital Overall Rateand Medians of Hospital Overall Rate

RATE

3.5

5.16.4 6.4

0.9 0.4

14

0.4

0

2

4

6

8

10

12

14

RATE

MedicineBurn TraumaGen. Surg.NeurosurgeryObstetricsPediatricsHigh risk nurseryWell baby nursery

Distribution of Major Infection Sites from all Distribution of Major Infection Sites from all patients and Major services, Hospital-Wide patients and Major services, Hospital-Wide

Component, NNIS System Component, NNIS System

Infection

ALL PERCENT OF CASES

TYPE HOSPITAL General Surgery

N=26,408

Medical

N=26,178

Newborn

N=3,220 UTI 33.1 30.2 42.1 4.2

Pneumonia 15.5 16.4 17.0 14.9

SSI 14.8 24.5 2.3 1.8

Others 23.4 19.4 23.8 43.1

Distribution of Major Infection Sites from all Distribution of Major Infection Sites from all patients and Major services, Hospital-Wide patients and Major services, Hospital-Wide

Component, NNIS System Component, NNIS System

Infection

ALL PERCENT OF CASES

TYPE HOSPITAL OB N=2,931

Gynecology N=1,882

Pediatric N=1,586

UTI 33.1 16.5 39.7 12.7

Pneumonia 15.5 2.3 6.5 12.7

SSI 14.8 45.0 37.2 6.1

Primary SSI

13.1 2.2 3.9 29.7

Others 23.4 34.0 12.7 38.8

Factors Promoting Factors Promoting Nosocomial InfectionNosocomial Infection

AgeAge Duration of hospitalizationDuration of hospitalization Surgery (type of operation)Surgery (type of operation) Immune status: chemotherapy, radiation therapy, Immune status: chemotherapy, radiation therapy,

malignancymalignancy Diagnostic technique and proceduresDiagnostic technique and procedures EnvironmentEnvironment PersonnelPersonnel PatientPatient OthersOthers

The “C ST” of The “C ST” of Hospital-Acquired InfectionHospital-Acquired Infection

PERSONNELPERSONNEL

Hospitalization, etc.Hospitalization, etc.

Income lossIncome loss

Repeat hospitalizationRepeat hospitalization

DisfigurementDisfigurement

DisabilityDisability

Pain, suffering etc.Pain, suffering etc.

DeathDeath


INSTITUTIONSINSTITUTIONS

Loss of RevenueLoss of Revenue

Extra duty and Time CostsExtra duty and Time Costs

Liability InsuranceLiability Insurance

MalpracticeMalpractice

ReputationReputation


NationalNational

PatientsPatients

InfectionsInfections

Days in HospitalDays in Hospital

COSTCOST

The “C ST” of The “C ST” of Hospital-Acquired InfectionHospital-Acquired Infection5-10% incidence of nosocomial 5-10% incidence of nosocomial

infectioninfection$550.00 average cost per infection $550.00 average cost per infection

(USA)(USA)7.4 average extra days in hospital7.4 average extra days in hospital$600-$2,000 extra direct hospital $600-$2,000 extra direct hospital

costcost

How do infections occur in How do infections occur in the Hospital Setting ?the Hospital Setting ?

How do Infections occur in How do Infections occur in Hospital Setting ?Hospital Setting ?

SOURCE/SOURCE/AGENTAGENT

SusceptibleSusceptibleHOSTHOST

Environment/Environment/Means ofMeans of

TransmissionTransmission

Sources of InfectionSources of Infection

EXOGENOUSEXOGENOUS• HandsHands• InstrumentsInstruments• CathetersCatheters• Respiratory equipmentRespiratory equipment• TransfusionsTransfusions• IV systemIV system• LinenLinen• AirAir

EndogenousEndogenousSources of InfectionSources of Infection

Oro - PharynxOro - PharynxRespiratoryRespiratory

GastrointestinalGastrointestinalS K I NS K I N

Causative AgentsCausative Agents

GRAM NEGATIVERODS

GRAM POSITIVECOCCI

OTHERS

Escherichia coli Staphylococcusaureus

Fungi -Candida sp.;Aspergillus sp.

Klebsiella sp. Staphylococcusepidermidis

Protozoans

Pseudomonasaeruginosa

Enterococci Mycobacteriumtuberculosis

Acinetobacter sp. Pneumocystiscarinii

Enterobacter sp. Anaerobes

Factors Promoting Factors Promoting Endogenous InfectionEndogenous Infection

OperationsOperations CathetersCatheters Foreign bodiesForeign bodies ChemotherapyChemotherapy Immuno- Immuno-

suppressionsuppression Pre-existingPre-existing

diseasedisease

SOURCEMeans of

TransmissionSusceptible

Host

AnimateAnimateInanimateInanimate

CONTACTCONTACT• DirectDirect• IndirectIndirect• DropletDropletAIRBORNEAIRBORNEVEHICLEVEHICLEVECTORVECTOR

DiseaseDisease

TherapyTherapy

Natural Natural ConditionsConditions

SOURCE OF INFECTIONSOURCE OF INFECTION

What is the degree of contamination in What is the degree of contamination in the person or object ?the person or object ?

What is the virulence of the organism ?What is the virulence of the organism ? What conditions are present in the object What conditions are present in the object

or person that favor survival and growth or person that favor survival and growth of microorganisms ?of microorganisms ?

What kind of contact will the object or What kind of contact will the object or person have with the potential host ? person have with the potential host ?


What is the degree of contaminationWhat is the degree of contamination

in the person or object ?in the person or object ?

““contamination is heavier with wet contamination is heavier with wet objects that dry objects...”objects that dry objects...”


What is the virulence of the What is the virulence of the organism ?organism ?

““As a general rule: the MORE virulent As a general rule: the MORE virulent the organisms, the LESS the number the organisms, the LESS the number

needed to produce the disease...”needed to produce the disease...”


What conditions are present in the object What conditions are present in the object or person that favor survival and growth or person that favor survival and growth of microorganisms ?of microorganisms ?


What kind of exposure will What kind of exposure will the object or person have the object or person have with the potential host ?with the potential host ?

MEANS OF TRANSMISSIONMEANS OF TRANSMISSION

CONTACTCONTACT DROPLETDROPLET AIRBORNEAIRBORNE VEHICLEVEHICLE VECTOR VECTOR

Means of TransmissionsMeans of Transmissions

CONTACT CONTACT - direct or indirect- direct or indirect

DROPLETDROPLET - > 5um- > 5um

AIRBORNEAIRBORNE- droplet nuclei; residue - droplet nuclei; residue

from evaporated dropletsfrom evaporated droplets

VECTORVECTOR - insects or animals - insects or animals

VEHICLEVEHICLE - food, water, blood, - food, water, blood,

medicationmedication

Means of TransmissionsMeans of TransmissionsCONTACTCONTACT- most common means of transmitting - most common means of transmitting

microorganisms from one person to anothermicroorganisms from one person to another

A. Direct ContactA. Direct Contact

- occurs when one person touches another- occurs when one person touches another

- direct contact is an ongoing process in the- direct contact is an ongoing process in the

hospitalhospital

- best vehicle : Hands- best vehicle : Hands

B. Indirect ContactB. Indirect Contact

- occurs when a person touches an inanimate- occurs when a person touches an inanimate

object contaminated by an infected patientobject contaminated by an infected patient

SUSCEPTIBLE HOSTSUSCEPTIBLE HOST

Factors that alter Host Factors that alter Host SusceptibilitySusceptibility

Chronic underlying diseasesChronic underlying diseases Immune deficiency statesImmune deficiency states MalignanciesMalignancies

Therapeutic measuresTherapeutic measures ImmunosuppressionImmunosuppression Antibiotic therapyAntibiotic therapy

Insertion or application of devicesInsertion or application of devices SurgerySurgery AGEAGE

SOURCEMeans of

TransmissionSusceptible

Host

AnimateAnimateInanimateInanimate

CONTACTCONTACT• DirectDirect• IndirectIndirect• DropletDropletAIRBORNEAIRBORNEVEHICLEVEHICLEVECTORVECTOR

DiseaseDisease

TherapyTherapy

Natural Natural ConditionsConditions

SOURCESOURCE


Means ofMeans ofTransmissionTransmission

INFECTIONINFECTION

ISOLATION TECHNIQUEAnimal and Insect Control

Nursing and Medical

Management

Infection Control Policies and Procedures

Patient CareHandling of supplies

and equipment

Improvement of Improvement of Host ResistanceHost Resistance

Decreasing the contact of the Decreasing the contact of the immunocompromised host to immunocompromised host to potential pathogens through potential pathogens through protective or reverse isolation protective or reverse isolation methodsmethods


Avoiding or Avoiding or removing factors that removing factors that impair host defenses. impair host defenses. Invasive devices Invasive devices should be avoided or should be avoided or should be removed should be removed as soon as possible. as soon as possible.


Immunotherapy, immunizations and Immunotherapy, immunizations and other methods of reconstituting other methods of reconstituting patients’ immune response maybe patients’ immune response maybe attemptedattempted


Early recognition and treatment of Early recognition and treatment of infections, and the utilization of infections, and the utilization of ancillary measures such as exercise ancillary measures such as exercise therapy to hasten recovery of therapy to hasten recovery of patientspatients

SOURCESOURCE



INFECTIONINFECTION


Nursing and Medical

Management



and equipment

Minimizing the Minimizing the RISK of INFECTIONRISK of INFECTION

• The environment should be HOSTILE The environment should be HOSTILE to the multiplication of pathogens to the multiplication of pathogens i.e. clean, dry and well ventilatedi.e. clean, dry and well ventilated


• All instruments and equipment All instruments and equipment should be clean and dry.should be clean and dry.

• Invasive items should be sterilized Invasive items should be sterilized and items in contact with mucous and items in contact with mucous membranes, body fluids and membranes, body fluids and potentially infectious materials potentially infectious materials should be disinfected.should be disinfected.


• The hands should be washed after The hands should be washed after handling infectious materials (e.g. handling infectious materials (e.g. bed linen, dressings, secretion and bed linen, dressings, secretion and excretions) and before aseptic or excretions) and before aseptic or surgical procedures. surgical procedures.

• The skin of the patient should be The skin of the patient should be disinfected before invasive disinfected before invasive procedures.procedures.


• Emphasize Emphasize HANDWASHINGHANDWASHING for for personal hygienepersonal hygiene


• All infectious materials (e.g. linen, All infectious materials (e.g. linen, clinical waste, sharps) should be clinical waste, sharps) should be safely contained, decontaminated or safely contained, decontaminated or destroyeddestroyed


• Food should be hygienically Food should be hygienically prepared, properly cooked and prepared, properly cooked and stored at low temperatures until usedstored at low temperatures until used


• Susceptible patients or sites should be Susceptible patients or sites should be protected from pathogenic protected from pathogenic microorganisms: i.e. dressing, isolation, microorganisms: i.e. dressing, isolation, barrier, nursingbarrier, nursing

• The resistance of susceptible host should The resistance of susceptible host should be enhanced when possible: vaccination, be enhanced when possible: vaccination, immunization and sometimes prophylactic immunization and sometimes prophylactic

antibiotics should be used antibiotics should be used

Control Measures for Healthcare-Control Measures for Healthcare-Associated InfectionAssociated Infection

Infection control measuresInfection control measuresChemoprophylaxisChemoprophylaxis ImmunoprophylaxisImmunoprophylaxisTherapyTherapyEmployee Health ProgramEmployee Health Program

SOURCESOURCE



INFECTIONINFECTION


Nursing and Medical

Management



and equipment

Control Measures for Control Measures for Nosocomial InfectionNosocomial Infection

InfectionInfectionControl Control MeasuresMeasures


CHEMO-CHEMO-PROPHYPROPHYLAXISLAXIS


IMMUNO-IMMUNO-PROPHYPROPHYLAXISLAXIS


THERAPYTHERAPYTHERAPYTHERAPYEmployeeEmployee

HealthHealthProgramProgram

EmployeeEmployeeHealthHealth

ProgramProgram

Standard PrecautionsStandard PrecautionsBarrier PrecautionsBarrier PrecautionsIsolation PrecautionsIsolation PrecautionsSterilizationSterilizationDisinfectionDisinfectionEnvironmental SanitationEnvironmental Sanitation

Standard PrecautionsStandard PrecautionsBarrier PrecautionsBarrier PrecautionsIsolation PrecautionsIsolation PrecautionsSterilizationSterilizationDisinfectionDisinfectionEnvironmental SanitationEnvironmental Sanitation











ProgramProgram

SURGICALSURGICALNON-SURGICALNON-SURGICAL

SURGICALSURGICALNON-SURGICALNON-SURGICAL











ProgramProgram

ACTIVE IMMUNIZATIONACTIVE IMMUNIZATIONPASSIVE IMMUNIZATIONPASSIVE IMMUNIZATION

ACTIVE IMMUNIZATIONACTIVE IMMUNIZATIONPASSIVE IMMUNIZATIONPASSIVE IMMUNIZATION











ProgramProgram

ANTIBIOTICANTIBIOTICIMMUNOTHERAPYIMMUNOTHERAPYSUPPORTIVESUPPORTIVE

ANTIBIOTICANTIBIOTICIMMUNOTHERAPYIMMUNOTHERAPYSUPPORTIVESUPPORTIVE











ProgramProgram

Hepatitis BHepatitis BscreeningscreeningTB ScreeningTB ScreeningImmunizationImmunization

Hepatitis BHepatitis BscreeningscreeningTB ScreeningTB ScreeningImmunizationImmunization

Principles in Infection ControlPrinciples in Infection Control The Health Care Worker (HCW) should The Health Care Worker (HCW) should

be aware of how infection is transmitted be aware of how infection is transmitted and the factors involved in the process.and the factors involved in the process.

The HCW should have the proper The HCW should have the proper attitude of infection control.attitude of infection control.

The HCW should be able to implement The HCW should be able to implement the MOST effective and applicable the MOST effective and applicable measures to prevent and control measures to prevent and control infection in his place of work.infection in his place of work.

Common Sense

inINFECTIONCONTROL

Infection Control is ..... a WAY of

LIFE

001 basic - epidemiology& principles prime 2015

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