50074187 Nosocomial Infections Epidemiology and Key Concepts

7/28/2019 50074187 Nosocomial Infections Epidemiology and Key Concepts

1/35

Nosocomial Infections

Epidemiology and key conceptsNelly Hassan Ali ElDin

Department of

Cancer Epidemiology & Biostatistics


2/35

Nosocomial infection:

It is an infection acquired in a medicalsetting in the course of medical treatment.It meets the following criteria:

1 - Not found on admission 2 Temporally associated with admission or

a procedure at a health-care facility 3 Was incubating at admission but

related to a previous procedure oradmission to same or other health-carefacility.


3/35

Why Nosocomial infection ?

It is an important public health problem because oftheir frequency, attributable morbidity andmortality and cost. In the USA and in Europe,approximately 510% of hospitalized patientsdevelop an infection during their hospital stay.Higher incidence rates are reported in hospitals indeveloping countries.

In our hospital (National cancer Institute,), bloodstream infections among pediatric patientsaccounted for 87.6/1000 discharges at 1999).Hospital acquired infection HAI contributed to37.5% of these episodes.


4/35

Monthly incidence of febrile episodes and associatedBSI rates per 1000 discharges in the pediatric

inpatient units from January to December 1999

0

100

200

300

400

500

600

700

800

Ja

n

Feb

Ma

rch

Ap

ril

Ma

y

Ju

ne

Ju

ly

Au

gust

Se

pt.

Oct.

No

v.

Dec

.

Month

Rate/1000discharge

Febrile episodes

BSI


5/35

Impact of nosocomial infection?

Increased morbidity (serious consequences and

permanent disability ) The length of hospital stay is prolonged, on average

by 510 days.

The risk of death approximately doubles in patients

who acquire hospital infection. Hospital-acquired infections are very expensive and

contribute significantly to the escalating costs ofhealth care. It has been argued that, even if

moderately effective, a hospital infection controlprogram is one of the most cost-effective andcost-beneficial preventative medical interventionscurrently available.


6/35

Definition of Nosocomial infectionThe use of uniform definition is crucial if data from one

hospital are to be compared with those of another hospital(inter-hospital) or with an aggregated database (intra-hospital).

NI is a localized or systemic condition:

1- that results from adverse reaction to the presence of an

infectiuos agent(s) or its toxins and2- that was not present or incubating at the time of admission

to the hospital.

For most bacterial NI, it become evident 48 hours or more(typical incubation period) after admission. Because theincubation period varies with type of pathogen, and extent ofthe underlying condition, each infection should be assessedindividually for evidence that links it to hospitalization.


7/35

Specific situations of NI

In superficial incisional surgical site infections(SSI) which involve only the skin orsubcutaneuos tissues, it occurs within 30days after the operation.

In deep incisional SSI which involves deep softtissues (fascia and muscles) and organ/spaceSSI which involves anatomic structures notopened or manipulated during operation, in

both conditions; it occurs 30days ofoperation or within one year if an implant ispresent.


8/35

Important principles upon which NIdefinitions are based

First (available information):

The information used to determine the presence andclassification of an infection should be a combination ofclinical findings, laboratory evidence and supportive data.

Clinical evidence is derived from direct observation of theinfection site or review of other pertinent sources of datasuch as the patients chart or medical record.

Laboratory evidence includes results of cultures, antigens orantibody detection or microscopic examination.

Supportive data are derived from other diagnostic studiessuch as: X-ray, US, CT, MRI, BAL, Endoscopy, ..etc


9/35

Second, (a physicians or surgeons diagnosis)

The diagnosis of infection by the surgeon or

physician is derived from direct observation duringa surgical operation, endoscopic examination orother diagnostic study or from clinical judgment.This diagnosis could be an acceptable criterion for

an infection unless there is compelling evidence tothe contrary.

For certain sites of infections, however, aphysicians clinical diagnosis in the absence of

supportive data must be accompanied by initiationof appropriate or empirical antimicrobial therapyto satisfy the criterion.


10/35

There are two special situations in which an infection isconsidered nosocomial:

a) Infection that is aquired in the hospital but does not becomeevident until after hospital discharge.

b) Infection in a neonate that results from passage through thebirth canal.

There are two special situations in which an infection is not

considered nosocomial:a) Infection that is associated with a complication or extensionof infection already present on admission, unless a change inpathogen or symptoms strongly suggests the acquisition ofnew infection.

b) In an infant, an infection that is known or proved to havebeen acquired transpalcentally (e.g congenital rubella,toxoplasmosis) and become evident at or before 48 hoursafter birth


11/35

There are two conditions that arenot infections:

1) Colonization, which is the presence ofmicroorganisms (on skin, mucousmembranes, in open wounds or in

execretions or secretions) that are notcausing clinical signs or symptoms. .

2) Inflammation, which is a condition that

results from tissue response to injury orstimulation by noninfectious agnets such aschemicals.


12/35

There are two additional points that are important tounderstand regarding the definition of NI:

Fisrt) the preventability of an infection is not aconsideration when determining whether it isnosocomial.

For example, preventing the development of

nosocomial C. difficle pseudomembraneous colitisafter extensive antibiotic treatment may not bepossible (i.e inevitable in some immunocompromisedpatients)

Another example some would argue that neonatalinfections acquired during vaginal delivery areinevitable and, therefore, should not be counted asnosocomial.


13/35

However, these neonatal infections are

nosocomial, they can be identified asmaternally acquired, and the analysis of theirincidence can be dissiminated to obestetriciansfor interventional strategies (i.e preventable).

Second), surveillance definitions are not intendedto define clinical disease for the purpose ofmaking therapeutic decisions. Some trueinfections (HIV infection) will, therefore, be

missed while other conditions (asymptomaticbacteruria) may erroneously be counted asinfections.


14/35

Goals for infection control andhospital epidemiologyThere are three principal goals for hospital

infection control and preventionprograms:

1. Protect the patients2. Protect the health care workers,visitors, and others in the healthcareenvironment.

3. Accomplish the previous two goals in acost effective and cost efficientmanner, whenever possible.

.


15/35

Function and organization of the

infection control program

The provision of an effective infection control program(ICP) is a key to the quality and a reflection of theoverall standard of care provided by the health careinstitution.

Major differences among countries in their health careresources and organization, and medical cultures explainthe diversity of approaches to the organization ofhospital hygiene and infection control programs.

The growth in ICP has been paralleled by theestablishment and growth of a number of professionaland governmental organizations which focus on NIprevention and control such as (APIC, SHEA, CDC,

HICPAC).


16/35

Infection control program

(ICP)In the majority of countries ICP,typically operates on two levels: an

executive body the infection controlteam(ICT) and an advisory body tothe hospital management the infection

control committee(ICC) which adoptsthe legislative role of policy making.


17/35

Infection Control Committee


18/35

Infection control Committee (ICC):

The hospital ICC is charged with the responsibilityfor the planning, evaluation of evidenced-basedpractice and implementation, prioritization andresource allocation of all matters relating to

infection control.The ICC must have a reporting relationship directly

to either administration or the medical staff topromote ICP visibility and effectiveness. The

ICC should meet regularly (monthly) according tolocal need


19/35

Infection Control Committee (cont):

The membership of the hospital ICC should reflect the

spectrum of clinical services and administrativearrangements of the health care facility. As a minimum,the committee should include:

1. Chief executive, or hospital administrator or his/hernominated representative.

2. ICD or hospital microbiologist (chairperson).3. Infection Control Nurse (ICN).

4. Infectious Diseases Physician (if available)

5. Director of nursing or his representative.

6. Occupational Health Physician (if available).7. Representative from the major clinical specialities.

8. Additionally representatives of any other department(pharmacy, central supply, maintenance,housekeepingetc) may be invited as necessary


20/35

The ICC has the following tasks:

To review and approve the annual plan

for infection control To review and approve the infection

control policies.

To support the IC team and directresources to address problems asidentified

To ensure availability of appropriatesupplies

To review epidemiological surveillancedata and identify area for intervention.


21/35


22/35

Infection Control Team (ICT):

It comprises the infection control doctorICD and infection control nurse ICN.The ICT is responsible for the day-to-day running of ICPs. It is important thatall hospitals should have an ICT. Theoptimal structure of ICT will vary withneeds and resources of the facility. The

ICT must have the authority to managean effective ICP. In large hospitals, thisusually means a direct reportingrelationship with senior administration


23/35

Role of Infection Control Team :

The role of ICT is to:

Ensure that an effective ICP has beenplanned, co-ordinate its implementation,

and evaluate the impact of suchmeasures.

It is important to ensure that there is a

24-hour access to the ICT for advice oninfection prevention and control whichwould include both medical and nursingadvice.


24/35

The role of Infection Control Team :

To develop an annual infection control plan withclearly defined objective.

To develop written policies and proceduresincluding regular evaluation and update.

To supervise and monitor daily practices ofpatient care designed to prevent infection.

To ensure availability of appropriate supplies

To organize an epidemiological surveillanceprogram (particularly in high risk areas for earlydetection of outbreak).

To educate all grades of staff in infectioncontrol policy, practice and procedures


25/35

The Role of Infection Control Team (cont):

To develop and implement annual training plan forall health care workers.

To have scientific and technical support role inpurchasing and monitoring of equipment andsupplies.

To participate with the pharmacy and antibioticcommittee in developing a program forsupervising the use of antibiotics.

To participate in the audit activity.

To submit monthly reports on activities to ICC.


26/35

Infection Control Doctor (ICD):


27/35

Infection Control Doctor (ICD):The infection control physician should be a

medically qualified senior staff of thefacility who is interested in and who spendsthe majority of his time involved in hospitalinfection control.

He could be a medical microbiologist, anepidemiologist or infectious disease physician

Irrespective of his professional background,

the ICD should have the interest, knowledgeand experience in different aspects ofinfection control.


28/35

The role and responsibilities of the ICD:

Serves as a specialist advisor and takes a leading

role in effective functioning of the ICT. An active member of ICC may be the chairman.

Assist the ICC in drawing the annual plan, policiesand long-term program for prevention & control of

hospital infection. Advises the hospital administrator directly on all

aspects of infection control

Participates in the preparation of tender documents

for support services Must be involved in setting quality standards,

surveillance and audit with regard to hospitalinfection.


29/35

Infection Control Nurse (ICN)


30/35

Infection Control Nurse (ICN)

An ICN or practitioner is a registered nursewith an additional academic education andpractical training which enables her to actas a specialist advisor in all aspects relating

to infection control.The ICN is usually the only full-time

practitioner in the ICT and thereforetakes the key role in day-to-day infectioncontrol activities with the ICD providing theleading role


31/35

The role of Infection Control Nurse

The role and responsibilities of the ICN aresummarized as follows:

Has an ongoing contribution to the developmentand implementation of IC policies and procedures,

participate in auditing and monitoring toolsrelated to IC and infectious diseases.

Provide specialist nursing input in theidentification, prevention, monitoring and control

of infections within the hospital Participate in surveillance and outbreak

investigation


32/35

The role of ICN (cont)

Identify, investigate and monitor infections,hazardous practice and procedures

Participate in the preparation of documentsrelating to service specifications and quality

standards.

Participate in training and educationalprograms and in membership of relevantcommittees where infection control input isneeded


33/35

How to achieve in infection control

Infection control is a quality managementfunction

A. Quality is defined by its attributes:effectiveness, efficiency, optimality,

acceptability, legitimacy, and equity.Quality is also the relationship ofstructure, process and outcome.

B. Quality is hassle elimination

C. Quality is the result of planning, monitoring(through measurement) and improvement(through team effort)..


34/35

Quality

Scientificapproach

Teamwork(Joiner traingle)

Improvements in quality are achieved byunderstanding processes, and variations andare supported by teamwork and scientific

approach


35/35

Thank you

50074187 Nosocomial Infections Epidemiology and Key Concepts

Documents

Transcript of 50074187 Nosocomial Infections Epidemiology and Key Concepts