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Dr Narender Saini

M.D.Chairman Hospital Infection

Control Committee

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HAI

Hospital Acquired infections are

infections if they first appear 48 hours or

more after hospital admission or within

30 days after discharge and extended

upto 12 month incase of implanted

device.

This type of infection is also known as

Healthcare-Associated Infection

Nosocomial- Greek word

nosokomeion

meaning hospital

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Incidence Of HAI

Developed countries: 6-10%

India: Around 20%

Socio-economic burden of HAI

delays discharge

HAI costs 2 times

direct cause deaths

Medico Legal issues

Reputation of the Hospital

Nearly 1/3rd are preventable

by effective hospital infection

control program

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HAI

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HAI is Increasing

y Compromised patients

y Ward and inter-hospital transfers

y Antibiotic resistance (MRSA, Resistant Gram

Negatives)

y Increasing workload

y Staff pressures

y Lack of facilities

y

Lack of concerny HAI is inevitable but some is preventable

y Realistically reducible by 30%

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Weakened immune systems

Some medical procedures bypass the body's natural protectivebarriers.

The staff themselves serve as a means for spreading pathogen.

Irrational use of antibiotic.

Hospital Environmental Factors

Causes Of HAI

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Patients own flora : Endogenous

Auto Infection (50%)

Sources of Infection

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Sources of Infection

Other People /Other People / Patient / Staff - Cross Infection (35%)

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Sources of Infection

Healthcare workers can get 100s to 1000s of bacteria on their hands

by doing simple tasks like:

pulling patients up in bed

taking a blood pressure or pulse

touching a patients hand

rolling patients over in bed

touching the patients gown or bed sheets

touching equipment like bedside rails, over bed tables, IV pumps

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Why Dont Staff Wash their Hands?

(Compliance estimated at less than 50%)

Sources of Infection

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Sources of Infection

Hand Wash, Why Not?

Skin irritation

Inaccessible hand washing facilities

Wearing gloves

Too busy Lack of appropriate staff

Being a physician

Lack of hand hygiene promotion

Lack of role model Lack of institutional priority

Lack of sanction for non-compliers

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Sources of Infection

Environmental (15%)

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Sources of Infection

Vectors

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Sources of Infection

Animals

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Sources of Infection

Fomites / Instrument (10%)

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Sources of Infection

Food-Stuffs

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Sources of Infection

Blood Contact

Direct inoculation of infective organism into bloodstream

Needle-stick injuries

Hepatitis B and C

HIV

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Sources of Infection

Vertical Transmission Transmission from mother to child in utero or during delivery

HIV, CMV

Breast-feeding can also result in transmission of infection from

mother to child

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Etiological Agents

Common HAI :

Bloodstream infections - 28%

Ventilator-associated pneumonia - 21%

Urinary tract infection (UTI) - 15%

Lower respiratory infection - 12%

Gastrointestinal, skin, soft tissue, and cardiovascular infections -10%

Surgical-site infections - 7%

Ear, nose and throat infections - 7%

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Etiological Agents

Etiologies in bloodstream infections

Coagulase-negative staphylococci - 40%

Enterococci - 11.2%

Staphylococcus aureus - 9.3%

Enterobacter species - 6.2%

Pseudomonas - 4.9%

Acinetobacter

Fungi - 9.65%

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Etiological Agents

Nosocomial etiologies in UTI

Gram-negative bacilli- 50%

Fungi - 25%

Enterococci - 10%

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Etiological Agents

Nosocomial etiologies in surgical-site infections

S aureus - 20%

Pseudomonas - 16%

Coagulase-negative staphylococci - 15%

Enterococci, fungi, Enterobacter species, and Escherichia coli

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Etiological Agents

Nosocomial etiologies in fever

Viral infections are most common causes of nosocomial fevers.

Phlebitis is the second most common cause of nosocomialfevers in the hospitalized child.

Clostridium difficile colitis is also a cause of nonsocomial fevers.

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Transmission

Micro-organism transmitted by several routes.

Five main routes.

Contact, Droplet, Airborne, Common vehicle and Vectorborne.

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Control of HAI

Based on knowledge of :

Source of infection

How infection is acquired

How infection is spread

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Control of HAI

GENERAL PRINCIPLES

Good general ward hygiene:

- No overcrowding- Good ventilation

- Regular removal of dust

- Wound dressing early in day

- Disposable equipment

HAND WASHING - Most Important

- Before and after patient contact

- Before invasive procedures

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Examples of Control of

Infection

Handwashing and protective clothing

Thank you for helping us to protect your family and friendsThank you for helping us to protect your family and friends

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Examples of Control of

Infection

Hand hygiene is the

simplest, most effectivemeasure for preventinghospital-acquiredinfections.

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Examples of Control of

Infection

Routine Hand Wash

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Examples of Control of

Infection

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Examples of Control of

Infection

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Examples of Control of

Infection

Hospital Design

Proper Ventilation

Isolation Rooms

Sanitation

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Preventing Cross

Infection

If known or suspected on admission to hospital, or detected

following admission:

- Isolation (barrier precautions)

- Inform Infection Control team

- Treatment - if appropriate

- Regular surveillance

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Surveillance

Early detection of trends outbreaks :

1. Laboratory BasedMicrobiology Laboratory lists +ve organismsICN reviews Alert organisms reported

2. Ward BasedWard staff monitor patientsICN reviews

ICN visits wards- Environmental swabs

3. Water

4. Kitchen

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Recommendations

I. Administrative Control

Education : Develop a system educate

patient and visitors.

Adherence to precautions : periodically

evaluate adherence to precautions use

findings to direct improvement.

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Respiratory Protection

-Wear respiratory protection patient with known or suspected

infectious.

Patient Transport

-Limit the movement and transport of the patient.

-If movement/transport is necessary mask the patient .

e.g. Tuberculosis, measles and chickenpox.

Airborne Precautions

Recommendations

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Patient Placement

Private room.

If cohorting then 3 feet distance between patients.

Special air handling.

Door may remain open.

Droplet Precautions

Recommendations

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Mask

Wear a mask when working within 3 feet of the patient.

Patient Transport

As described in airborne precaution.

E.g. meningitis, influenza, mumps, rubella.

Droplet Precautions

Recommendations

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Contact Precautions

Use in addition to standard precautions.

Patients infected/colonised epidemiologically important micro-organism -

transmitted by direct/indirect contact.

a). Patient placement-private room\cohorting

b). Gloves, Gown and Handwashing.

c). Patient transport limit the movement -precautions minimize risk of

transmission of micro-organism.

e). Patient care equipment adequate cleaning and disinfection\sterilization.

e.g. ATB-resistant bact, Hepatitis A.

Recommendations

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HAI Control Program

Training of staff

Investigation of out break

Controlling the out break by rectification of technical

lapsis Monitoring of staff health to prevent staff to patient and

patient to staff spread of infection

Advice on procedures and infection control measure

Inspection of waste disposal, laundry and kitchen Monitoring and advice on safe use of antibiotic

Monitoring of HAI and Infection control audit

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Conclusion

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Hospital Infection Control

Committee Chairperson : HOD Consultant - Microbiologist Dr Narendra Saini

Co- Chairperson : Manager Medical Services, Quality and Accreditation MsMandakini

C

onvener : Infection Control Nurse Ms. Sunita Ninan

Members : CMD/ED Dr Vinay/Vijay Aggarwal

Dir. Med. Services Dr Naveen Jain Advisor -Dr Manju Mani

Anesthesia depart Dr Swaraj Garg GM M/E -Mr Sanjeev

Sharma

ER / Critical Care - Dr Amit Gupta Physician Dr Prakash Gera

Neurosurgeon Dr.Rajkumar CNO Ms Nomita Sarkar

GM HS & Trg Mr Mitul Patel

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Any Questions???

Thank you !!!