dalin healthcare associated infection
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Infection Control of
Healthcare Associated InfectionBoerhan Hidayat
Infection control committee
Dr.Soetomo General HospitalSurabaya
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What are hospital infections?
Two types of infections youfind in the hospital
Hospital-acquired infections
Community-acquired infections
How can we distinguishthem?
By latency period
CDC definition for NIs:development of infectionsafter 48 hours of admission
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What kinds of hospital infections exit?
Device-related
Blood stream infections (BSI)
Urinary tract infections (UTI)
Ventilator-associated pneumonia (VAP)
Procedure-related
Surgical site infections (SSI)
Environmental contamination
Water, disinfectant, etc.
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Why do we need to study hospital
infections?Not all hospital infections arepreventable, but they are associated
with Excess length of hospital stay
Excess cost
Excess mortality
Law suits
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Distribution of hospital infections by sites,
SENIC study
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Increases in the mean length of hospital stay due to
hospital infections
in the U.S. , SENIC study
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Excess cost of hospitalization due to hospital
infections in the U.S., 1992
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Who are at risk for acquiring hospital
infections?
Patients in Intensive Care Units ICU medical, surgical, burn, Neonatal
ICUPediatric ICU) Surgery department
Immunocompromised patients Cancer treatment, transplant, HIV
infections
Other factors Age, smoking, chronic diseases
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Distribution of hospital infections by infection
sites and endemic/outbreak status
Endemic
Outbreak
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Nosocomial Pathogens By Infection Type
Pneumonia UTI BSI SSI
S. Au reus 19% 2% 16% 20%
Coag (-) staph 2% 4% 31% 14%
Enterococcus 2% 16% 9% 12%
Pseudomonas 17% 11% 3% 8%
Other gram (-) 29% 45% 17% 23%
C. albicans
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Host
Agents
Environment
Infection control
Nutrition
Vaccination
Hand washing
IPD
Environm. manag
(Biol & Non-Biol)
Waste
Aseptic
Antibiotics
Eradication
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Key Prevention Strategies
Prevent infection
Diagnose and treatinfection effectively
Use antimicrobials
wisely
Prevent transmission
Clinicians hold the solution!
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TYPES BY ORIGIN
1.Endogenous:Caused by the organisms that are present
as part of normal flora of the patient
2. Exogenous:Caused by organisms acquiring by exposur
to hospital personnel, medical devices orhospital environment
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Chain of Infection
+
Quantity ofpathogen
Virulence Route oftransmission
Sensitivehost
Port
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Transmission Of Infectious Agents In All Settings
Requires 3 Interrelated Elements
Source
Mode ofTransmission
SusceptibleHost
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MIKROORGANISM (AGENT)
BACTERIA
VIRUSES
FUNGI
PARASIT
RICKETTSIA PROTOZOA
PATHOGENESITYVIRULENCEINVASIONNUMBER
Flora:
Transient Resident
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VIRULENCE
SEVERITY OF DISEASES
MORBIDITY MORTALITY TRANSMISSION LEVEL
INVASIVE ORGANISMINTACT TISSUE(SKIN, MUCOSE, ECT)
NUMBER OF BACTERIA
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Epidemiologically Important Organisms
Antibiotic-resistant organisms such asmethicillin-resistant Staphylococcus
aureus (MRSA), vancomycin-resistantEnterococcus (VRE), and multidrug-resistant gram-negative bacilli arebeing isolated with increasing
frequency* Clostridium difficile has been
increasing in many US hospitals*NNIS Report 1992-2000. Am J Infect Control 2000;28:429.
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S. aureus
Penicillin
[1950s]
Penicillin-resistant
S. aureus
Evolution of Drug Resistance inS. aureus
Link to: CDC Facts about VISA Link to: CDC Facts about VRE
Methicillin
[1970s]
Methicillin-resistant
S. aureus (MRSA)
Vancomycin-resistant
enterococci (VRE)
Vancomycin
[1990s]
[1997]
Vancomycin
intermediate-resistant
S. aureus
(VISA)
[ 2002 ]Vancomycin-
resistantS. aureus
Link to: MMWR on VRSA
http://www.cdc.gov/ncidod/hip/vanco/vanco.htmhttp://www.cdc.gov/ncidod/hip/Aresist/vre.htmhttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm5126a1.htmhttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm5126a1.htmhttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm5126a1.htmhttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm5126a1.htmhttp://www.cdc.gov/ncidod/hip/Aresist/vre.htmhttp://www.cdc.gov/ncidod/hip/vanco/vanco.htm -
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Pandemic MRSA clonesUK (42%)
Australia
(30%)
Latin
America(29%)
USA
(36%)
Africa
Nigeria (21%)
Zimbabwe (43%)
South Africa (49%)
Taiwan (61%)
Japan (74%)
Denmark/Norwegian
Netherlands (
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Vancomycin-resistant Enterococci
Nosocomial Isolates in EuropeNosocomial Isolates in the USA
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New Resistant Bacteria
Emergence of AntimicrobialResistance
Susceptible Bacteria
Resistant Bacteria
Resistance Gene Transfer
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Antimicrobial Resistance:
Key Prevention Strategies
OptimizeUse
Prevent
ransmission
Prevent
Infection
EffectiveDiagnosis& Treatment
PathogenAntimicrobial-Resistant Pathogen
AntimicrobialResistance
Antimicrobial Use
Infection
Susceptible Pathogen
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Transmission of Infectious Agents in Healthcare
Settings
Individuals are exposed to human sources ofmicroorganisms by three primary routes:
Contact transmission Direct organism is transferred directly from one person to
another, e.g. scabies or herpetic whitlow Indirect- organism is transferred through contaminated
intermediate object or person, e.g. hands or contaminatedpatient care equipment
Droplet Transmission- relatively large ( >5 microns) dropletheavy with moisture that are propelled relatively short distances
from the source (3-6 feet) onto the mucous membranes of the nose,mouth or eyes, of the host and environmental surfaces
Airborne Transmission- droplet nuclei (
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Routes of Transmission
Respiratory Cough
Sneeze
Fecal-oral Feces contaminate food, environment, or
hands
Vector-borne Transmitted by insects
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Transmission of Influenza Viruses
SeasonalInfluenza in
Humans
Current AvianInfluenza in Humans
Droplet most likelyroute
possible
Airborne possible atclose distances
possible at close
distances
Contact possible Most likely
(bird to human), and
possible (human to
human)
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Chain Model of Infectious Disease
Control Points
RespiratoryHygiene/Cough Etiquette
Education Cover coughs, using tissue
or surgical mask Hand hygiene Spatial separation
Standard precautions Handwashing Personal Protective
Equipment
Standard Precautions(continued)
Patient Placement
Safe work practices
Medical waste handling
Environmental cleaning anddisinfection
Expanded precautions:- Contact
- Droplet
- Airborne infection isolation
- Empiric
Interrupt TRANSMISSION In Healthcare(Including Home And Community Treatment) Settings:
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Goals for infection control and hospital
epidemiology
There are three principal goals for hospitalinfection control and preventionprograms:
1. Protect the patients
2. Protect the health care workers, visitors,and others in the healthcare environment.
3. Accomplish the previous two goals in acost effective and cost efficient manner,whenever possible.
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M i T k f I f ti
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Main Task of Infection
Control Committee
Develop policies
Training andeducations
AdvocacySurveilance
Reporting and
recommendation
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INFECTIONCONTROL
For the management
and
Departments concerned
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Problems Identification
&
Risk Factors
Analyse
Recommendation
Monitoring & Evaluation
Implementation
Surveillance
Reporting
Evaluation
Advocacy
&
Quality
Control
Advocacy&
QualityControl
Working CapacityOf ICC
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Conclusions
Infection control is very essential toreduce the HAI
Not all HAI can be prevented, but they
are associate with LOS, cost, mortality andlaw suit
Infectious Disease Control Points
Contain the source Interrupt transmission
Reduced susceptibility of the host
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