prevention of hospital acquired infection.ppt
DESCRIPTION
Prevention of HAI.hospital acquired infectionpreventionPrevention of HAI.vvPrevention of HAI.TRANSCRIPT
PREVENTION OF HOSPITAL ACQUIRED INFECTIONS
S. VIVEK ADHISH
Professor
NIHFW
Definition
An infection acquired in hospital by a patient who was admitted for a reason other than infection.
An infection occurring in a patient in a hospital or other health care facility in whom the infection was not present or incubating at the time of admission.
This includes infections acquired in a hospital but appearing after discharge
Significance
Leading Cause of Death
Economic Costs
Increased length of stay
Loss of livelihood
Increased use of drugs
Drug Resistance
A Study in US in 1995 revealed that :-
Rate of hospital acquired infection: 1 in every 10 admitted patients.
Resulted in 88,000 deaths.
Annual cost: 4.5 billion to 11 billion$.
Deaths because of HAI: 5%.
Over last 25 years Nosocomial Infection rates have remained stable at 5-6 HAI per 100 admissions (CDC).
However, in terms of infections per 1000 patient days it has increased by 36% from 7.2 in 1975 to 9.8 in 1995.
Global Scenario
Major cause of death and increased morbidity.
A prevalence study by WHO in 55 hospitals in 14 countries across globe representing 4 regions showed that :
Average rate of HAI – 8.7%
At any given point of time 1.4 million people world wide suffer from infections complication acquired in hospital
RATES OF HAI IN DIFFERENT REGIONS:
East Mediterranean region: 11.8%
South East Asia region: 10%
Western Pacific Region: 9.0%
European Region: 7.7%
Highest rate of HAI in ICU, acute surgical ward and orthopedic wards.
Rates highest among susceptible patients i.e. old age with underlying disease, chemotherapy.
Studies in India
Hospital Infection Rates: 2-15%
Contributory mortality rate: 3%
Post Op. wound infection rate: 10-32%
Commission Set-up by British Parliament in 1996 to review Nosocomial Infection reported:
• Nosocomial Infection cannot be eradicated.• 30% could be avoided by better application of
existing knowledge and realistic operation control practices.
• 50 -70% of surgical would infection occur post discharge (UK) but only a quarter of infection control team doing post discharge surveillance.
• No written policies for use of catheters hand washing.
• Nosocomial Infection National Surveillance Scheme developed in 1996.
• National Programme on Hospital Infection Control may be initiated.
Sources of HAI
Endogenous: These would be from the patient himself.
Exogenous:• Other patients• Hospital staff• Environment• I/V medicines• Blood• Air• Apparatus
1. Hospital pathogen drug resistant
10. Impaired defense 9. Transplantation
2. Poor hygiene
3. Crowding of Patients
4. Instrumentation and surgery 5. Extreme of age
8. malignancy
7. Burns
6. Implanted Prostheses
HospitalInfections
Risk Factors For HAI
Low resistance of patients to infections.Contact with infectious persons.Invasive procedures/ interventions.Inappropriate antimicrobial usage.Drug resistance of endemic microbes.Contaminated environment.
Patient susceptibility
• Age• Immune status• Underlying disease• Diagnostic and therapeutic intervention
Environmental factors
Bacterial resistance
AirWash bowls Dust and other dry
environment
Food
Water, disinfectants, solutions, etc.,
Ventilators Urinals, bed pan
Surfaces contaminated with patient’s secretions, excretions, body fluids, etc.
IV fluid equipment
Surgical instruments (endoscope, cystoscope, bronchoscope, etc.
Nosocomial Infection Site (In order of frequency ) Urinary tract Lower respiratory tract Surgical site Skin and soft tissue Bacteraemia Catheter site Other
High Risk Areas in Hospitals
NurseriesIntensive Care UnitsDialysis UnitsOrgan Transplant UnitsOncology WardsOperation TheatresDelivery Rooms & Post Op Wards.
The spread of infection within the hospital requires three essential elements:
A source of infecting organisms. A means of transmission of the organism A susceptible host
The transmission may occur: By direct or indirect contact Through airborne, vehicle, or vector means
Nosocomial infection rate equation
# of nosocomial infections for the month X 100 # of discharges for the month
Reservoirs and Transmission
Endogenous: Transmission to site outside natural habitat e.g. Urinary
tract, wound (damage to skin)Inappropriate antibiotic therapy allowing over growth
Exogenous Cross Infection: (from other patient or member of staff):Microorganisms are transmitted between patients
Strategies
Risk Stratification:• All patients are not at equal risk. We should assess
risk of HAI and accordingly practice patient care practices.
• Aseptic measure should be appropriate to the level of risk.
Differential Nosocomial Infection risk by patient and intervention
Risk of Infection Type of Patients Type of Procedures
1. Minimal Not immuno-compromised ; no significant underlying disease
Non-invasiveNo exposure to biological fluids
2. Medium Infected patients, or patients with some risk factors (age, neoplasm)
Exposure to biological orHigh risk invasive procedures (e.g. peripheral venous catheter, introduction of urinary catheter)
3. High Severely immuno-compromised patients, (<500 WBC per ml); multiple trauma, severe burns, organ transplant
Surgery or High risk procedures (e.g. central venous catheter, endotracheal intubation
Aseptic Measures Appropriate for Different Levels of Risk of Infection
Risk of Infection
Asepsis Antiseptics Hands Clothes Devices
1. Minimal Clean None Simple hand washing or disinfection by rubbing
Street clothes Clean or disinfected at intermediate or low level
2. Medium Asepsis Standard antiseptic products
Hygienic hand washing or hand disinfection by rubbing
Protection against blood and biological fluids, as appropriate
Disinfected at sterile or high level
3. High Surgical asepsis
Specific major products
Surgical hand washing or surgical hand disinfection by rubbing
Surgical clothes: dress, mask, caps, sterile gloves
Disinfected at sterile or high level
Reducing Person To Person Contamination : Hand Washing Is Key.
TYPES OF HAND WASH Simple Hand Wash Hygienic Hand Wash Surgical Hand Washing Hand Disinfection by Rubbing Surgical Hand Disinfection by Rubbing
Simple Hand Wash
Hand washing limited to hands and wrist Use non-antiseptic soap
Hygienic Hand Wash
Area as above. Use antiseptic soap (follow manufacturer instructions e.g..
one minute)
Surgical Hand Washing Area includes hands and forearms With antiseptic soap 3-5 minutes
Hand Disinfection By Rubbing
Use alcohol, rub on hand and wrist (alcohol rubs consists of antiseptics and emollient gels) as per manufacturer’s instruction
Surgical Hand Disinfection By Rubbing
Hand and forearm Simple hand wash followed by drying Two application of alcoholic rub and rub to dry for duration as
per manufacturer’s recommendations.
PREVENTING TRANSMISSION FROM ENVIRONMENT
Cleaning of Hospital Environment
Routine cleaning is very essential. 90% of micro-organism in visible dust and routine cleaning remove this.
Hospital housekeeping services should have schedule of cleaning which has frequency and use of agents specified.
It should include schedule for cleaning floor, walls, windows, beds, curtain, screen, fixture, furniture, bath toilet and all reusable medical devices
Cleaning of Hospital Environment (Cont.)
Proper methodAppropriate levels of cleanliness. For this we may
classify hospital into zonesZone A : No patient contact : Administration OfficeZone B : Patients not infectedZone C : Patient infected : Isolation RoomZone D : Highly susceptible patient : OT, ICU
Level of Cleaning Zone A : Domestic cleaning
Zone B : No dry mopping/vacuum Wet mopping
Disinfect before mopping Use detergentZone C : Ideally separate equipment for each room Use detergent/disinfectant solutionZone D : Ideally separate equipment for each room Use detergent/disinfectant solution
All horizontal surface and toilets to be cleaned daily in zone B, C and D.
Use of Hot WaterSanitary Equipment: 80º C 1 Min.Cooking Utensil: 80º C 1 Min.Linen: 70º C 25 Min.
95º C 10 Min.
Disinfection of Patient EquipmentRemove micro-organisms without complete sterilization to
prevent transmission of organism
Infection Control CommitteeChairman: Director/ Medical SuperintendentMembers :• Heads of Major Departments• Operation Theater• Nursing Chief• Infection Control Officers• Nurse• CSSD• ICU • OPD• Casualty• Kitchen• Laundry• Cleaning services • Purchasing Equipment Committee• Making Alterations and Letting Agencies.
• Infection Control Team– ICO– IC Nurse – Microbiologist– Epidemiologist– Software– Clerk
• 1 Full Time Practitioner 1/200 Teaching Referral;
• 1/300 Community Hospital
Functions of the Infection Control Nurse Experienced nurses are appointed full time on this
position Regular visit to all wards and high risk units. Checking nursing supervisor’s register & records
suggestive of infection. Collection and tabulation of daily data of incidence of
hosp infection– Identification and location of pt– Date of admission– Date of infection– Type of infection– Cultures taken, antibiotics taken– Name of treating physician
Surveillance of HAI
Reducing infection rates in the hospital Establishing endemic baseline rates Identifying & containing outbreaks Evaluating & monitoring all infection control
measures Monitoring antimicrobial susceptibility patterns
Dept of Microbiology carries out surveillance of HAI with the help of infection control team.
Prevention of Nosocomial Infection
Key components are :-Limiting transmission of organism between
patient– Hand washing– Gloves– Aseptic practice– Isolation– Disinfection and sterilization
Controlling environment risk for infection
• Appropriate use of prophylactic antimicrobials nutrition and vaccination
• Limiting endogenous infection by– Minimising invasive procedure– Appropriate use of antibiotics
• Surveillance• Prevention of infection in staff• Enhancing staff patient care practices and
continuing staff education.
DisinfectionCritical Items
– Sterilization
Semi-critical Items– High level disinfection– Intermediate level disinfections
Non-critical Items– Low level disinfection
Universal Precautions
Blood and fluids visibly contaminated with blood.Also semen and vaginal secretions, tissues and body fluids
Body Substance Isolation
Faces, urine, sputum , saliva, wound drainage etc.
Success Factors
• Leadership• Co-ordination• Partnerships• Communication• Consistency of information• Sharing
HEALTHCARE ACQUIRED INFECTION
Needs to be managed across health and social care systems as an integral part of
patient safety
The Way Forward
• Protocols for all procedures
• Guidelines for handwashing, cleaning, disinfection etc
• Functional Infection Control Committees and Infection Control Teams
• Surveillance
• National Progamme or prevention of hospital acquired Infections