Darline Dupree PhD Student Walden University PUBH 8165-2 Instructor: Dr. Robert Marino Winter 2012.

Healthcare-Associated Infections Occurring in Hospitals

Darline DupreePhD Student

Walden UniversityPUBH 8165-2

Instructor: Dr. Robert MarinoWinter 2012

Hospital Board of Directors OSHA County Public Health Departments Center for Disease Control (CDC) Environmental Health Department Healthcare Practitioners

Stakeholders

Generate awareness concerning Hospital-Associated Infections (HAIs)

Generate awareness regarding the varying types of HAIs

Generate awareness regarding the financial burden that HAI’s pose on hospitals

Promote practitioners adherence to infection prevention guidelines

Promote the enhancement of Infection Surveillance Systems

Improve hospital infectious control policies Promote quality of care practices that minimize

HAI risk

Objectives

Define Hospital Associated Infections Explain HAI impact on public health Identify four of the most common infections occurring in

hospitals Name preventative measures used to prevent/control

HAIs Explain the impact of HAI on low-income developing

countries Explain HAI surveillance systems Identify states with laws requiring HAI reporting Understand the importance of activating infection control

requirements

At The End Of This Presentation You Will Be Able To:

• “Hospital-Associated Infections (HAI) are infections caused by a wide variety of common and unusual bacteria, fungi, and viruses during the course of receiving medical care” (CDC, 2011)

• Infections that develop during hospitalization that are not present nor incubating upon the patient’s admission to the hospital (Collins, 2008)

What are Hospital-Associated Infections (HAIs)?

Center for Disease Control and Prevention. Healthcare associated infections. Retrieved on January 19, 2012 from: http://www.cdc.gov/hai/ Collins A., S. (2008) Preventing Healthcare –Associated infections, Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2683/

Traditional hospital Outpatient surgery centers Long-term care facilities Rehabilitation centers Community clinics

Healthcare Settings Vulnerable to Infections

Health◦ 1 out of every 20 patients contract some form of

hospital related infections ◦ HAI is responsible for approximately 90, 000

deaths annually

Financial◦ Responsible for approximately $28.4 billion to

$33.8 billion dollars in direct healthcare cost◦ Responsible for approximately $8.5 billion in

overall hospital net cost

Public Health Burden of HAI

Center for Disease Control and Prevention. Healthcare associated infections: Burden. Retrieved on January 19, 2012 from: http://www.cdc.gov/HAI/burden.html

Scott, D. R. (2009). The Direct Medical costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. Retrieved on January 30, 2012 from: http://www.cdc.gov/HAI/pdfs/hai/Scott_CostPaper.pdf

Device related infections◦ Central Line-Associated Bloodstream Infection

(CLABSI)◦ Catheter-Associated Urinary Tract Infection

(CAUTI)◦ Ventilator-Associated Pneumonia (VAP)

Procedure related infections ◦ Surgical Site Infection (SSI)

Types of HAIs

Center for Disease Control and Prevention. Healthcare associated infections: Infection Types. Retrieved on January 1, 2012 from http://www.cdc.gov/HAI/infectionTypes.html

UTI accounts for 36% SSI accounts for 20% Bloodstream infection (BSI) accounts for

11% Pneumonia accounts for 11%

Most common type of infections occurring in hospitals within the US annually

World Health Organization (2011). Report on the Burden of Endemic Health Care-Associated Infection Worldwide: Clean Care is Safer Care (ISBN 978 92 4 150150 7))

◦ Most common type of hospital-associated infections

◦ Responsible for between approximately 75%-97% of urinary tract infections in the hospital

◦ Accounts for approximately > 30% of HAIs infections

◦ Responsible for an Estimated 13,000 HAI deaths annually

◦ Occurs when bacteria enters the urinary tract through the urinary catheter

◦ Prolonged use of urinary catheter increase the risk for infections

Catheter Associated Urinary Tract Infection (CAUTI)

World Health Organization (2011). Report on the Burden of Endemic Health Care-Associated Infection Worldwide: Clean Care is Safer Care (ISBN 978 92 4 150150 7).

Center for Disease Control and Prevention. Healthcare associated infections: Retrieved January 15, 2012 from: http://www.cdc.gov/HAI/pdfs/toolkits/CAUTItoolkit_3_10.pdf

Perform proper hand hygiene practices in accordance to CDC recommended standard precautions

Insert catheters only when needed Remove catheters immediately when the

need for it no longer exist Use aseptic techniques for insertions Maintain a closed drainage system

Preventing CAUTIs

Center for Disease Control and Prevention. Top CDC Recommendations to Prevent Healthcare Associated Infections. Retrieved on January 30, 2012 from: http://www.cdc.gov/HAI/prevent/top-cdc-recs-prevent-hai.html

Infection occurring after surgery in the part of the body that was operated on

Accounts for approximately 300,000 of all HAI cases

Responsible for 75% of SSI associated deaths

Infections range from superficial to serious Approximately 12% to 84 % of surgical site

infections are discovered after patients are released from the hospital◦ most infections discovered within 21 days after surgical

operation

Surgical Site Infection (SSI)

Center for Disease Control and Prevention. Healthcare associated infections: FAQs about SSI. Retrieved January 15, 2012 from: http://www.cdc.gov/HAI/ssi/faq_ssi.html

Collins A., S. (2008) Preventing Healthcare –Associated infections, Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2683/

Administer antimicrobial prophylaxis Prepare surgical site of skin with an

antiseptic agent Treat remote infections prior to performing

operations Use sterilized instruments to perform surgery Maintain a sterile environment by limiting

traffic in the operating room Use sterile dressings to protect incisions

Preventing SSI

Center for Disease Control and Prevention. Top CDC Recommendations to Prevent Healthcare Associated Infections. Retrieved on January 30, 2012

from: http://www.cdc.gov/HAI/prevent/top-cdc-recs-prevent-hai.html

◦Occurs when bacteria or viruses enters the bloodstream through the catheter

◦Marked by fever and soreness around the area where the catheter was inserted

◦Responsible for up to 35% of HAI related mortalities

◦Responsible for approximately 87% of BSI

Central Line-Associated Bloodstream Infection (CLABSI)


Center for Disease Control and Prevention. Healthcare associated infections: Retrieved January 15, 2012retrieved from :http://www.cdc.gov/HAI/pdfs/toolkits/CLABSItoolkit_white020910_final.pdf


Select an insertion site least vulnerable to infections

Wear sterile surgical protective gear Properly insert central lines Use appropriate agent for skin antisepsis Remove central line when no longer needed

Preventing Central Line-Associated Bloodstream Infection


◦Lung infection that develop in a person who is on a ventilator

◦Infection occurs when germs enter the tube and accumulate in the patient’s lungs

◦Accounts for 83% of hospital associated pneumonia

Ventilator-Associated Pneumonia (VAP)

World Health Organization (2011). Report on the Burden of Endemic Health Care-Associated Infection Worldwide: Clean Care is Safer Care (ISBN 978 92 4

150150 7)


Elevate the bed of patients( varies based upon age in pediatrics)

Remove the ventilator as soon as the patient is able to breathe without it.

Preventing VAP


Antibiotic associated◦ Clostridium difficile infection (CDAD)

Antibiotic resistant infections◦ Methicillin-resistant Staphylococcus aureus

(MRSA) Infection

Emerging Infections Commonly Associated With HAI

Spore-forming, gram-positive anaerobic bacillus bacterium Accounts for 15%-25% of all episodes of antibiotic-

associated diarrhea Responsible for 9,000 deaths annually Occurs most often in elderly people and people with

certain medical problems Causes diarrhea and other serious intestinal conditions Transmission

◦ Contaminated bed linens, bed rails, bathroom fixtures and medical equipment

◦ Person to person on the hands of hospital personnel and visitors

Clostridium difficile Infection (C.diff)

Center for Disease Control and Prevention. Healthcare associated infections. Retrieved on January 14, 2012 from: http://www.cdc.gov/HAI/organisms/cdiff/Cdiff_faqs_HCP.html

Center for Disease Control and Prevention. Healthcare associated infections: Retrieved January 15, 2012 from: http://www.cdc.gov/HAI/pdfs/toolkits/CDItoolkitwhite_clearance_edits.pdf


Clean and disinfect equipment and overall environment

Utilize contact precautions during the duration of diarrhea

Isolate symptomatic patients Implement universal glove use

Preventing Clostridium difficile Infections (CDI)


Staph bacteria resistant to certain antibiotics Occurs more often among patients who undergo invasive

medical procedures or who have weakened immune systems

Causes severe and potentially life-threatening infections 25% of MRSA cases occur in the hospital Transmission

◦ Spread from patient to patient on unclean hands of healthcare personnel or through the improper use or reuse of equipment

◦ Hands may become contaminated with MRSA by contact with: colonized or infected patients; devices, surfaces contaminated with body fluids, infected hospital personnel

Methicillin-Resistant Staphylococcus Aureus (MRSA) Infection

Center for Disease Control and Prevention. Hospital associated infections: Methicillin-resistant Staphylococcus aureus (MRSA) Infection. Retrieved on January 14, 2012 from: http://www.cdc.gov/HAI/organisms/mrsa-infection.html Center for Disease Control and Prevention. Symptoms of MRSA. Retrieved on January 14,2012 from: http://www.cdc.gov/mrsa/symptoms/index.html Center for Disease Control and Prevention. Protect Yourself from MRSA . Retrieved on January 14, 2012 from: http://www.cdc.gov/Features/MRSAinHealthcare/


Implement contact precautions for colonized and infected MRSA patients

Immediately report MRSA lab results

Preventing MRSA


Endogenous◦ Body sites that house microorganisms as part of

the normal microbial flora Ex. skin, nose, mouth gastrointestinal tract, vagina

Exogenous ◦ Sources external to the patient

Ex. medical devices, health-care workers, healthcare environment, visitors, patient care equipment

Contributing Factors of HAI

WHO (2011) Report on the burden of Endemic Health Care- Associated Infection Worldwide. Retrieved on January, 14, 2012 from http://whqlibdoc.who.int/publications/2011/9789241501507_eng.pdf

◦ Compromised immune systems ◦ Primary immunodeficiency (e.g., anemia or

autoimmune disease)◦ Secondary immunodeficiency’s (e.g.,

chemotherapy, corticosteroids, diabetes, leukemia)

Patient Susceptibility

Collins A., S. (2008) Preventing Healthcare –Associated infections, Retrieved on January 14, 2012 from: http://www.ncbi.nlm.nih.gov/books/NBK2683/

Patients admitted to ICUs Burn patients Transplant patients Neonates

High Risk Patients

Examining the Global Burden of HAI

HAI is an issue that extends past our US borders

HAIs are more frequent in resource-limited settings than in developed countries

What is Known

WHO(2011)Health care-associated infections :FACT SHEET. Retrieved on January 12, 2012 from http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf

15 out of every 100 patients hospitalized in low-income developing countries acquire HAI

SSI is the leading infection within the general patient population

Central vascular lines, ventilators, and urinary catheters are approximately 19 times higher in low- income countries

Newborn HAI rates are 3- 20 times higher in low-income developing countries then in high income countries◦ Responsible for 4% to 56% of all causes of death with the

numbers increasing to 75% in countries such as South-East Asia and Sub-Saharan Africa.

HAI is more frequent in critically-ill patients admitted to ICUs. ◦ Account for 42.7 episodes per 1000 patient-days in developing

countries

HAI in Low-income Developing Countries

WHO(2011)Health care-associated infections :FACT SHEET. Retrieved on January 14,201 from http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf

Insufficient environmental sanitary conditions and waste disposal

Meager infrastructure Inadequate equipment Understaffing Overcrowding Poor knowledge and application of basic infection

control measures Nonexistent local and national guidelines Insufficient hospital policies Unawareness of injection and blood transfusion safety

Determinants of HAI Specific to Low-income Countries

Pathway to Addressing the Problem

“Primary prevention offers the hopes of eliminating unnecessary illness, injury, and even death” (Cohen et al, 2010)

Improves health Reduces Cost Requires concerted efforts by all healthcare

practitioners, public health officials, governmental officials and the general public

Primary Prevention is Key

Cohen, L., Chavez, V., Chehimi, S. (2010). Prevention is Primary. San Francisco, CA: Josey-Bass

Implement policies for the development of HAI prevention programs◦ Action Plan to Prevent Healthcare Associated Infections ◦ 29 states and the District of Columbia passed laws

related to HAI prevention◦ 3 States developed reporting procedures that don’t

require legislations Activate infection control requirements.

◦ Appropriate training, accreditation and licensure to encourage adherence to infection control requirements

Encourage continued research to acclimatize surveillance protocols and preventive strategies.

Focus of Prevention at the National and International Level

Center for Disease Control and Prevention and Association of State and Territorial Health Officials (2011) Eliminating Healthcare Associated Infections. Retrieved from http://www.cdc.gov/HAI/pdfs/toolkits/toolkit-HAI-POLICY-FINAL_03-2011.pdf

Establish minimum reporting requirements for all healthcare facilities

Status of current Surveillance System National Healthcare Safety Network (NHSN)

Secure web-based system that facilitates reporting from healthcare facilities

Mandated by 23 states and the District of Columbia Intended use in approximately 5,000 hospitals within the

U.S.23 developing countries (23/147) reported a functioning national surveillance system

Focus of Prevention at the National and International Level

Center for Disease Control and Prevention and Association of State and Territorial Health Officials (2011) Eliminating Healthcare Associated Infections. Retrieved from: http://www.cdc.gov/HAI/pdfs/toolkits/toolkit-HAI-POLICY-FINAL_03-2011.pdf

Alabama California Colorado Connecticut Delaware Washington D.C. District of

Columbia Florida Hawaii Illinois Maine Maryland Massachusetts Minnesota Missouri New Hampshire

New Jersey New Mexico New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina Tennessee-limited Texas Virginia Vermont Washington West Virginia

U.S. States With Laws Requiring the Reporting of Hospital Associated Infections

The committee to reduce infectious disease (2011). Retrieved on January 12, 2012 from : http://www.hospitalinfection.org/legislation.shtml

Minimize environmental exposure

◦ Implement standard precautions to include best hand hygiene practices

Develop hospital policies and procedures geared toward protecting health and safety◦ Include appropriate preventive measures for hospital related infection risks

Train staff on the principles of infection control

◦ comply with requirements for staff education and training as established through existing federal, state, and local regulations

Coordinate efforts with the infection control department in monitoring and investigating potentially harmful infectious exposures and outbreaks among personnel

Focus Prevention at the Hospital Level

American Recovery and Reinvestment Act◦ Signed into law on February 17, 2009 ◦ Designed to stimulate economic recovery in

various ways including strengthening the nation's healthcare infrastructure and reducing healthcare costs

◦ Authorize $50 million to support states in the prevention and reduction of Healthcare Associated Infections

Positive Strides Toward HAI Prevention

Center for Disease Control and Prevention. Healthcare associated infections: Retrieved on January 15, 2012 from: http://www.cdc.gov/HAI/recoveryact/

Patient Protection and Affordable Care Act of 2010◦ Health Reform◦ Reimbursement of Medicare/Medicaid funding

contingent upon HAI prevention ◦ CMS Hospital Inpatient Quality Reporting Program

de facto national mandate 95% of hospitals participates in this program

◦ Requires hospitals to report select infections CLABSI’s in ICUs Certain SSI

Positive Strides Toward HAI Prevention

Center for Disease Control and Prevention and Association of State and Territorial Health Officials (2011) Eliminating Healthcare Associated Infections. Retrieved from http://www.cdc.gov/HAI/pdfs/toolkits/toolkit-HAI-POLICY-FINAL_03-2011.pdf

Be proactive◦ Partner with other agencies to enhance

prevention strategies◦ Familiarize yourself with the statues and

regulations surrounding HAI prevention◦ Foster relationships with and engage stakeholders

in HAI programs Educate the public on HAI

Moving Forward

Hospital Associated Infections poses a serious threat to the health and financial viability of the healthcare system in general.

The elimination of HAI is going to take a concerted effort from all healthcare practitioners

In order to improve infectious control policies and enhance infection surveillance systems, there must be collaboration and involvement from policymakers, and governing/regulatory entities

Focus must be placed on better educating service providers on infection control techniques

Conclusion

Questions

Center for Disease Control and Prevention. Healthcare associated infections: Burden Retrieved on January 19, 2012 from: http://www.cdc.gov/HAI/burden.html

Center for Disease Control and Prevention. Healthcare associated infections: Infection Types. Retrieved on January 1, 2012 from http://www.cdc.gov/HAI/infectionTypes.html

Center for Disease Control and Prevention and Association of State and Territorial Health Officials (2011) Eliminating Healthcare Associated Infections


Center for Disease Control and Prevention. Healthcare associated infections: Retrieved January 15, 2012 from: http://www.cdc.gov/HAI/pdfs/toolkits/CAUTItoolkit_3_10.pdf

Center for Disease Control and Prevention. Healthcare associated infections: FAQs about SSI. Retrieved on January 15, 2012 from: http://www.cdc.gov/HAI/ssi/faq_ssi.html

Collins A., S. (2008) Preventing Healthcare –Associated infections, Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2683/

References

Center for Disease Control and Prevention. Healthcare associated infections. Retrieved on January 14, 2012 from: http://www.cdc.gov/HAI/organisms/cdiff/Cdiff_faqs_HCP.html

Center for Disease Control and Prevention. Healthcare associated infections: Retrieved on January 15, 2012 from: http://www.cdc.gov/HAI/pdfs/toolkits/CDItoolkitwhite_clearance_edits.pdf

WHO(2011)Health care-associated infections :FACT SHEET. Retrieved from http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf

Center for Disease Control and Prevention. Healthcare associated infections: Retrieved on January 15, 2012 from: http://www.cdc.gov/HAI/recoveryact/

Cohen, L., Chavez, V., Chehimi, S. (2010). Prevention is Primary. San Francisco, CA: Josey-Bass

Scott, D. R. (2009). The Direct Medical costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. Retrieved on January 30, 2012 from: http://www.cdc.gov/HAI/pdfs/hai/Scott_CostPaper.pdf

Center for Disease Control and Prevention and Association of State and Territorial Health Officials (2011) Eliminating Healthcare Associated Infections Retrieved from http://www.cdc.gov/HAI/pdfs/toolkits/toolkit-HAI-POLICY-FINAL_03-2011.pdf

References

• Infection Control Policies and Hospital-Associated Infections Among Surgical Patients: Variability and Associations in a Multicenter Pediatric Setting. (www.pediatrics.org/cgi/doi/10.1542/peds.2004-2014)

• Diseases and Organisms in Healthcare Settings. (www.cdc.gov/HAI/organisms/organisms.html)

• National healthcare Safety Network (NHSN) Report, data summary for 2010, device associated module (www.cdc.gov/nhsn/PDFs/dataStat/2009NHSNReport.pdf)

Resources for Further Reading

Darline Dupree PhD Student Walden University PUBH 8165-2 Instructor: Dr. Robert Marino Winter 2012.

Documents

Transcript of Darline Dupree PhD Student Walden University PUBH 8165-2 Instructor: Dr. Robert Marino Winter 2012.