HOSPITAL ACQUIRED

INFECTIONSDEPARTMENT OF COMMUNITY

MEDICINE

MODERATED BY: DR DHIRAJ SRIVASTAVA

PRESENTED BY: SANCHITA SAINIROLL NO.66

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DEFINITION• Infections that develop within a

hospital or are produced by microorganisms,acquired during hospitalization, within 48hrs.

• Also called as “NOSOCOMIAL INFECTIONS.”

• ‘Nosus’ means disease.

• ‘Kameion’ means to take care of.

DEFINITION BY C.D.C

Infections that the patients acquire during the course of receiving treatment for other conditions, or acquired by the Healthcare Workers while performing their duties in healthcare settings.

HOST FACTORS

THE AGENT

EPIDEMIO-

LOGICAL INTERAC

T-ION

ENVIRONMEN

T

SOURCES OF INFECTION

2 SOURCES :

EXOGENOUS• Outside the

human body

ENDOGENOUS• By Normal human

flora

• Caused by organisms acquired by exposure to hospital personnel, medical devices or hospital environment.

EXOGENOUS INFECTIONS

• Caused by organisms that are present as a part of normal flora of the patient.

ENDOGENOUS

INFECTIONS

SURGICAL SITE INFECTIONS

• Any purulent discharge, abscess, or spreading cellulitis at the surgical site during the month after the operation.

• The infection is usually acquired during the operation itself; either exogenously (e.g. from the air, medical equipment, surgeons and other staff), endogenously from the flora on the skin or in the operative site or, rarely, from blood used in surgery

URINARY TRACT INFECTIONS

Positive urine culture (1 or 2 species) with at least 105 bacteria/ml, with or without clinical symptoms.

MOST COMMON NOSOCOMIAL INFECTION

80% of infections are associated with the use of an indwelling bladder catheter

RESPIRATORY INFECTION

• Respiratory symptoms with at least two of the following signs appearing during hospitalization:

Cough Purulent sputum New infiltrate on chest

radiograph consistent with infection.

BLOOD STREAM INFECTIONS

Represent a small proportion of nosocomial infections.

Case fatality : >50% Organisms involved :

o Multi resistant coagulase- negative Staphylococcus

o Candida spp.

MODES OF TRANSMISSION

ROUTES OF SPREAD

CONTACT AIR BORNE EXOGENOUS

CONTACT TRANSMISSION

(MOST COMMON MODE OF

TRANSMISSION)

CONTACT

DIRECT INDIRECT

HANDS,AUTOINOCULATION,EQUIPMENT.

BEDPANS,DRESSINGS,CONTAMINATED GLOVES

AIR BORNE TRANSMISSION

• DROPLET NUCLEI IN THE ATMOSPHERE

• RESPIRATORY SECRECTIONS ON SURFACE (FOMITES)

EXOGENOUS INFECTIONS SITES

IN HOSPITAL-INFECTIONS

STATUS IN INDIARISK OF INFECTION High in India.

• Approx. 19,900 neonatal deaths/year due to sepsis.

• 5-10% of patients admitted to acute care hospitals acquire infections.

• 2 million patients/year affected.

• 90,000 deaths/year

• 1/4th of nosocomial infections occur in ICUs.

• 70% are due to antibiotic resistant organisms

PREVENTING NOSOCOMIAL INFECTIONS

ISOLATION• Infectious patients MUST be isolated.

• Patients susceptible to infection should not be placed in the beds next to patients who are a source of infection.

MEASURES BY HOSPITAL STAFF

• Those suffering from infectious ailments should be kept away from work until completely cured.

• They should be careful about PERSONAL HYGIENE.

• Aprons & Outer clothing should be regularly changed.

HAND WASHING

HAND HYGIENEHANDS ARE THE MOST IMPORTANT VEHICLES OF HAI TRANSMISSION•THOUSANDS OF PEOPLE DIE EVERYDAY FROM INFECTIONS WHILE RECEIVING HEALTH CARE •MOST IMPORTANT MEASURE TO AVOID THE TRANSMISSION OF HARMFUL MICROORGANISMS.

ANY HEALTHCARE WORKER/PERSON INVOLVED IN DIRECT/INDIRECT PATIENT CARE

WHY?

WHO?

WHY DON’T STAFF WASH HANDS?

• THE COMPLIANCE ESTIMATED IS LESS THAN 50%

• SKIN IRRITATION• WEARING GLOVES• TOO BUSY FOR REGULAR HAND WASHING• LACK OF APPROPRIATE STAFF

DUST CONTROL• Dust is released during SWEEPING, DUSTING

& BEDMAKING.

• Suppression by WET DUSTING VACUUM CLEANING

PROPER DISPOSAL OF HOSPITAL

WASTECOLOR WASTE TREATMENT

YELLOW Human & animal anatomical waste/Microbiology waste and

soiled cotton/dressings/linen/bedding

etc.

INCINERATION/ DEEP BURIAL

RED Tubing/catheters/i.v. sets etc. AUTOCLAVE/MICROWAVE/

CHEMICAL TREATMENT

BLUE/ WHITE

Waste sharps (needles,syringes,scalpels,blades

etc.)

AUTOCLAVE/MICROWAVE/

CHEMICAL TREATMENT/

DESTRUCTIONBLACK Discarded medicines/

cytotoxic drugs/incineration ash/chemical waste

DISPOSAL IN LAND FIELDS

DISINFECTION• Disinfection prevents transmission of

organisms between patients.

• LEVELS OF DISINFECTION:

o HIGH LEVEL - destroys all the microorganisms except heavy contamination by bacterial spores.

o INTERMEDIATE LEVEL – inactivates M.tuberculosis, vegetative bacteria, most viruses & fungi.

o LOW LEVEL – kills most bacteria, some viruses & some fungi.

STERILISATION• Operationally, defined as decrease in

microbial load to 10-4.

• Done for o Medical devices penetrating sterile body siteso Parenteral fluidso Medicationso Reprocessed equipment

• The objects must be wrapped after sterilization to maintain its viability for longer durations of time.

CONTROL OF DROPLET INFECTION

Use of face-mask

Proper bed-spacing

Prevention of overcrowding

Ensure adequate ventilation

IMPROVING NURSING

TECHNIQUES• BARRIER NURSING is the effective measure.

• Its Aim is to protect medical staff against infection by patients, especially with highly infectious diseases.

ADMINISTRATIVE MEASURES

• Formation of a hospital “CONTROL OF INFECTION COMMITTEE” to formulate the policies regarding admission of infectious cases, isolation facilities & disinfection procedures.

• Formation of a CSSD (Central Sterile Supply Department) in every hospital.

STANDARDS TO BE MAINTAINED

IN HOSPITAL

• An attempt should be made to achieve and maintain an average count of 10-

15 bacteria/cubic foot of air in hospital.

• Less than 5 bacteria/cubic foot – minimal risk of infection.

• More than 35 bacteria/cubic foot – high risk of infection

Guideline to evaluate the floor

cleaning procedure(based on R.O.D.A.C plate count)

• 0-25 bacteria/cubic foot - good floor cleaning procedure.

• 26-50 bacteria/cubic foot – satisfactory.

• >50 bacteria/cubic foot – not satisfactory.

C.S.S.D• Supply of sterile instrument & material for

dressing & procedure carried out in the wards and departments.

• Sterilization of instruments & linen for use in O.T.

• Disinfection & Sterilization of medical equipment.

• Selection & distribution of single use sterile supplies such as catheters, suction tubes, syringes.

C.S.S.D OF UPRIMS&R, SAIFAI

MANUAL STEAM STERILIZER

SEMI-AUTOMATIC STEAM STERILIZER

AUTOMATIC STEAM STERILIZER

ETO(ETHYLENE TRIOXIDE)

STERILIZER

WASHER DISINFECTOR

ULTRASONIC CLEANER

GLOVE WASHER

GLOVE DRYER

GLOVE POWDERING

MACHINE

BIBLIOGRAPHY• Park’s Textbook of Preventive & Social Medicine

23rd edition

• Bennett and Brachman’s Hospital Acquired Infections by William R. Jarvis

• Hospital Administration by Francis & de ’Souza

• Prevention of Hospital Acquired Infections WHO GUIDELINES

• CDC – www.cdc.gov/cdc.htm

• CSSD of UPRIMS&R, Saifai, Etawah – 206130

THANK YOU