Hospital Acquired Infection 11-11-11
Transcript of Hospital Acquired Infection 11-11-11
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HOSPITAL ACQUIRED(NOSOCOMIAL) INFECTION
Salimah DossaMAC,(UK) MSCN,BSCN,(USA) PGD,Specialization in
Psychiatric Nursing & Advance Midwifery, RNM(AKUH)
Murshid Hospital & Health Care Centre
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Welcome to the hospital!Bugs are waiting for you!!!
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DEFINITION:
ANY INFECTION ACQUIRED BY A PATIENT
IN HOSPITAL
OR
Infections that occur during hospitalization but are not
present nor incubating upon hospital admission
"nosus" = disease"komeion" = to take care of
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Why Do HAI Occurs
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Who
All hospitals?
All departments?
All specialties?
Other health institutions?
Why Not?
Working in high-risk areas
Lack of hand hygiene promotion
Lack of role model
Lack of institutional priority
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Common Sources of HAI
Reservoirs & Routes of Transmission
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SOURCES
1.Patients own flora - Endogenous (50%)
Auto-Infection
(Greatest source of potential danger)
2.Environment - Exogenous (15%)
(Air-5%; Instruments-10%)
3.Another Patient/Staff - Cross Infection (35%)
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Reservoir & Route of Transmission
Pathogen Transmission Susceptible host
Fungus Contact Visitors
Bacteria Vector Health care workers
Parasite Vehicle Patients
Virus Droplet
Airborne
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Clinical Features of HAI
Pain
Fever
Night Sweat
Inflammation
Breathing Difficulties
Rapid Breathing
Mental Confusion
Low blood Pressure
Reduce Urine Output WBC high count
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Hospital Associated Infections
HAI
Risk Factors
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ICUs Are Dangerous Places!!!
The sickest pts are placed in proximity
Anti Biotics are given empirically in large doses
Devices are everywhere (often pts have 3, 4 or more)
Busiest unit in the hospital
Uses the most sophisticated
equipments
Higher infection rates:
Severity of illness
Frequent use of invasive devices Staff busy caring for very ill pts
Staff move from one pt to other without washing hands
Longer ICU stay prolonging the risk of exposure
Space limitations, ?risk of contaminating equipments
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Sources of Cross Infections in ICUs
Hands of staff and attendants
Assisted ventilation equipments
Suction and drainage bottles
IV lines (central and peripheral)
Urinary catheters
Wounds and wound dressings
Disinfectant containers
Dressing trolleys
Bed rails Phones and computers keyboards
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Healthcare-Associated Infections inICU
UTI (catheter associated)
Pneumonias
Catheter-related
bloodstream infections
Surgical sites infections
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NICU Major Risk Factors for HAI Low birth weight
Exposure to invasive devices Acuity of underlying illness
Surgery
Viral infections
Increase duration of hospitalization
Use of broad spectrum A/B
Overcrowding
Poor staffing ratios
Rates of infections in NICUs have varied from 6 to 40%
New Born requires surgery
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Importance of Prevention &Control of HAI
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Preventing HA Infections
Decrease morbidity
Decrease mortality
Decrease hospital stay
Decrease hospital cost (self or third party payers)
Decrease spread ofMDR pathogens to pts, Health Care
Workers, visitors,
Prevent bad reputation of a hospital & legal actions
Prevent Loss of accreditation
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What Can
We Do?
Measures to Reduce the Risk of HAI
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Control of HA Infection
Effective IC program to control transmission of infection
to patients, HCW, visitors
A multidisciplinary committee that oversees the program
Responsibility assigned to qualified people Written policies and procedures for all pt care services &
departments
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Strategies to Reduce
Infection Risk
Assessment of pts upon admission to the unit for infectious risk:Diarrhea
Rashes or skin lesions
Recognized communicable diseases
Known carrier of an epidemic strain of bacterium
Isolation
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Many Personnel Dont Realize When
They Have Germs on Their Hands
Healthcare workers can get 100s to 1000s ofbacteria on their hands by doing simple taskslike: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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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 contactbefore invasive procedures
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Why
Dont Staff Wash their Hands(Compliance estimated at less than 50%)
Why Not?
Skin irritation
Inaccessible hand washing facilities
Wearing gloves
Too busy
Lack of appropriate staff
Being a physician
( Improving Compliance with Hand Hygiene in Hospitals Didier Pittet. Infection Control and Hospital Epidemiology.Vol. 21 No. 6 Page 381)
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Areas Most Frequently Missed
HAHS 1999
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Routine Hand Wash
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Prevention
Protection
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Environmental Factors and Design Issues
Beds: at least 2.5-3 m in ICUs apart to allow movement of
staff and equipment and to reduce risk of cross
contamination
Sharp containers within easy access
Privacy partitions made of material easily cleaned weeklyand any time it becomes soiled
Curtains should be changed weekly and in between
Pts Windows should remain closed to control airborne risks
Plants and flowers should not be allowed in the units
Sinks should be placed near the entrance and at key points
Sinks assigned for hand washing should not be used to wash
instruments
Waterless hand rub dispensers at entrance and each bedside
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Infection Control Measures in the NICU
Proper nursery design
Incubators or heating beds spacing of 6 feet
One sink in a unit
Filters should be at least 90% efficient
Access to isolation rooms
Avoid admissions of pts with contagious disease or place in isolation
room
Special protection during constructions
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Employees in the NICU Represent a possible vehicle for transmission of infectious agents
Should be immune to rubella, measles, polio, Hep B, and influenza Employees who have suffering form any infectious disease should be
excluded from work
Orientation should include:
Basic infection control concepts
Hand hygiene
Management of sharp objects
Wear proper attire
Gowns should be used for isolation and when soiling is possible
Wearing of employee scrubs is of no IC benefit
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Visitations in the NICU
Policies should be flexible and liberal but safe
Parents should be encouraged to visit
A trained HCW should interview visitors outside of the nursery to
assess their health
No persons with symptoms of an acute contagious illness should be
allowed to visit
Should perform appropriate hand hygiene
No contact with pts other than the one they are visiting
Should not handle pt care equipment
Visitor restrictions may be necessary during community outbreaks,
particularly RTI such as influenza
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Environmental Cleaning Cleaning with the hospital approved agent
All surfaces must be wiped with a damp cloth to remove dust anddirt
In the nursery chemicals should be used with extreme caution since
absorption through the skin can cause further more demage
Appropriate high-level disinfection or sterilization of equipments
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We can only prevent what wecan understand !!!
All units should have :
Histograms about frequency of common pathogens
Time-trended surveillance data on different HAI
Data on specific AB susceptibility patterns Education about risks of HAI
Provide meaningful feedback to HCWs
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If HAI not Treated or HAI Result in:
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Conclusion
Hospital Pathogen Unhappy
patients
Hospital SurveillanceHappy
Patients
Unhappy
Director / CEO
Happy
Director / CEO
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Any Questions???
Thank you for not asking!!!
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tHanK YoU fOr yoUr cOopeRatiOn anUnTiriNg sUPpoRt FoR LiStEnIng