hospital acquired infection ( nosocomial infection )
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Transcript of hospital acquired infection ( nosocomial infection )
NOSOCOMIALINFECTION
YASH RAMAWATM.Sc. NsgRAJ KUMARI AMRIT KAUR COLLEGE OF NURSING DELHI
Meaning
Cro
mial
"komeion"
"to take care of."
Noso-
"nosus“
"disease"
MAGNITUDE OF HAIS
In a World Health Organization (WHO) cooperative study (55 hospitals in 14 countries), about 8.7% of hospitalized patients had nosocomial infections.in India the nosocomial infection rate is at over 25-30%.
About 25-36% of these infections are preventable through the adherence to strict guidelines by health care workers when caring for patients.
MAGNITUDE OF HAIS (CONT.…)
Slide Title• A prospective study of 71 burn patients at Post Graduate Institute of Medical Education and Research (PGIMER) in Chandigarh found that up to 59 patients (83 per cent) had hospital-acquired infections: 35 % S. aureus
24 % P. aeruginosa 16 % haemolytic streptococci.
S. aureusP. aeruginosa
haemolytic streptococci
0%
5%
10%
15%
20%
25%
30%
35%
Series 1
A six-month study conducted in the intensive care units (ICUs) at All India Institute of Medical Sciences (AIIMS) in New Delhi, found that 140 of 1,253 patients (11 per cent) had hospital-acquired infections, where P. aeruginosa made up 21 per cent of isolates, 23 per cent were S. aureus, 16 per cent Klebsiella spp., 15 percent Acinetobacter baumannii and 8 per cent Escherichia coli.
25%
28%19%
18%
10%
SalesP. aeruginosa S. aureus Klebsiella sppAcinetobacter baumannii Escherichia coli
11
H.A.I. INCREASING: in
· compromised patients· ward and inter-hospital transfers· antibiotic resistance (MRSA, resistant Gram
negatives)· increasing workload· staff pressures· lack of facilities· ? lack of concern
HAI is inevitable but some is preventable (irreducible minimum)
· realistically reducible by 10-30%
12
HAI - common bacteria Staphylococci - wound, respiratory and
gastro-intestinal infections Escherichia coli - wound and urinary tract
infections Salmonella - food poisoning Streptococci - wound, throat and urinary
tract infections Proteus - wound and urinary tract
infections (Peto, 1998)
13
HAI - common viruses Hepatitis A -
infectious hepatitis Hepatitis B - serum
hepatitis Human
immunodeficiency virus [HIV] - acquired immunodeficiency syndrome [AIDS] (Peto, 1998)
SOURCE OF INFECTIONEndogenous/
direct: Caused by the
organisms that are present as part of normal flora of the patient (50 %)
Exogenous/indirect Caused by organisms acquiring
by exposure to hospital personnel, medical devices or hospital environment, cross-infection from medical personnel (35 %)
hospital environment- inanimate objects 15%· air , dust , IV fluids & catheters · Washbowls, bedpans ,
endoscopes · ventilators & respiratory
equipment · water, disinfectants etc
Exogenous source15
16
CDC estimates major infections are caused common microbes
According to the CDC, the most common pathogens that cause nosocomial infections are Staphylococcus aureus, Pseudomonas aeruginosa, and E. coli. Some of the common nosocomial infections are urinary tract infections, respiratory pneumonia, surgical site wound infections, bacteremia, gastrointestinal and skin infections.
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Strategies to control nosocomial infection
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REDUCING PERSON-TO-PERSON TRANSMISSION
PREVENTING TRANSMISSION FROM THE ENVIRONMENT
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REDUCING PERSON-TO-PERSON TRANSMISSION
Hand decontamination Mask, eye protection/face shieldGownClothing Gloves
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HAND DECONTAMINATION
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Many Personnel Don’t Realize When They Have microbes on Their Hands
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 patient’s hand◦rolling patients over in bed◦touching the patient’s gown or bed sheets◦ touching equipment like bedside rails, overbed tables, IV
pumps
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Hand washingSingle most effective action to prevent HAI -
resident/transient bacteriaCorrect method - ensuring all surfaces are cleaned -
more important than agent used or length of time taken
No recommended frequency - should be determined by intended/completed actions
Research indicates:◦poor techniques - not all surfaces cleaned◦frequency diminishes with workload/distance◦poor compliance with guidelines/training
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Before touching a patient
Before aseptic procedures
After body fluid exposure/risk
After touching the patient
After touching the patient's surrounding
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PREVENT TRANSMISSION FROM THE ENVIRONMENT
• CLEANING OF ENVIRONMENT• CLEANING OF EQUIPMENT• FOLLOW TRANSMISSION BASED PRECAUTION• SPECIFIC STRATEGIES• CONTROL OF ENVIROMENT FACTOR• ADMINISTRATIVE MEASURE
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YASH 27
PREVENTION OF ENVIRONMENT TO PATIENT TRANSMISSION
ENVIRONMENT DECONTAMINATION
Cleaning of hospital environment. This may be achieved by classifying areas into one of four hospital zones-
Zone A: no patient contact. Normal
domestic cleaning (e.g. administration, library).
Zone B: care of patients who are not
infected, and not highly susceptible. Cleaning with detergent solutions.
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YASH 28
Zone C: infected patients (isolation wards).
Clean with a detergent/disinfectant solution, with separate cleaning equipment for each room.
Zone D: highly-susceptible patients
(protective isolation) or protected areas such as operating suites, delivery rooms, intensive care units, premature baby units, casualty departments and haemodialysis units.
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CLEANING OF EQUIPMENTS Disinfection procedures must_ Meet criteria for killing of organisms_ Have a detergent effect_ Act independently of the number of bacteria present, the degree of hardness of the
water, or the presence of soap and proteins (that inhibit some disinfectants). To be acceptable in the hospital environment, they must also be:_ Easy to use_ non-volatile_ not harmful to equipment, staff or patients_ free from unpleasant smells_ effective within a relatively short time.
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levels of disinfectionHigh-level disinfection (critical) — this will destroyall microorganisms, with the exception of heavy contamination by
bacterial spores.Intermediate disinfection (semi-critical) — this inactivates
Mycobacterium tuberculosis, vegetative bacteria, most viruses and most fungi, but does not necessarily kill bacterial spores.
Low-level disinfection (non-critical) — this can kill most bacteria, some viruses and some fungi, but cannot be relied on for killing more resistant bacteria such as M. tuberculosis or bacterial spores.
These levels of disinfection are attained by using the appropriate chemical product in the manner appropriate for the desired level of disinfection.Disinfection of patient equipment
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SterilizationAnd
Disinfection
Definitions: Sterilisation :
– It is a process by which an article, surface or medium is made free of all microorganisms either in vegetative or spore form.
Disinfection :– Destruction of all pathogens or organisms capable of
producing infections but not necessarily spores.– All organisms may not be killed but the number is
reduced to a level that is no longer harmful to health.
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Antiseptics :– Chemical disinfectants which can safely
applied to living tissues and are used to prevent infection by inhibiting the growth of microorganisms.
Asepsis :– Technique by which the occurrence of
infection into an uninfected tissue is prevented.
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Methods
1.Physical methods
2.Chemical methods
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Physical methods:• Physical
methods:1.Sunlight 2.Heat
1.Dry heat2.Moist heat
3.Filtration 4.Radiation
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Chemical methods• Chemical methods:
1. Alcohols2. Aldehydes3. Phenols4. Halogens5. Oxidizing agents6. Salts7. Surface active agents8. Dyes9. Vapor phase disinfectants
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Physical Methods
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Sun light:
• Sun light:– Active germicidal
effect due to its content of ultraviolet rays .
– Natural method of sterilisation of water in tanks, rivers and lakes.
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HEAT
• two type– DRY HEAT– MOIST HEAT
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Dry heat:1.Red heat2.Flaming 3.Incineration 4.Hot air oven
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Red heat: Materials are held
in the flame of a bunsen burner till they become red hot.» Inoculating
wires or loops» Tips of forceps» Needles
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FlamingMaterials are passed
through the flame of a bunsen burner without allowing them to become red hot.
» Glass slides» scalpels» Mouths of culture
tubes
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Incineration: • Materials are
reduced to ashes by burning.
• Instrument used was incinerator.
• Soiled dressings• Bedding • Pathological material
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Hot air oven: • Most widely used method• Electrically heated and fitted with a fan to
even distribution of air in the chamber.• Fitted with a thermostat that maintains
the chamber air at a chosen temperature.• Temperature and time:
» 160 C for 2 hours.» 170 C for 1 hour» 180 C for 30 minutes.
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MOIST HEAT STERILIZING
• below 100° – pasteurization – Vaccine bath
• At 100°– boiling– Tyndalization
• Above 100°– autoclave
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TEMPERATURE BELOW 100o C (PASTEURISATION)
Uses – for serum or other
body fluids containing
proteins.
HOLDER METHOD – Heating
at 63o C for 30 minutes.
FLASH PROCESS – Heating at
72o C for 15-20 seconds.Wednesday, May 3, 2023 46YaSh
Principle of Pasteurization
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INSPISSATION.
Inspissation is done between 75°C to 80°C. Inspissation means stiffening of protein without coagulation as the temperature is below coagulation temperature. Media containing serum or egg is sterilized by heating for 3 successive days. It is done in 'Serum Inspissator'.
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A temperature at 100°C
II. A temperature at 100°C
1. Boiling 2. Tyndallisation
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1 Boiling for 10 – 30 minutes may kill most of vegetative forms but spores with stand boiling.2. Tyndallisation :
Steam at 100C for 20 minutes on three successive days
Used for egg , serum and sugar containing media.
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Temperatures above 100°CIII. A temperature
above 100°CAutoclave : -Steam above
100°C has a better killing power than dry heat.
-Bacteria are more susceptible to moist heat.
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Components of autoclave:
• Components of autoclave:– Consists of vertical or horizontal cylinder of
gunmetal or stainless steel.– Lid is fastened by screw clamps and
rendered air tight by an asbestos washer.– Lid bears a discharge tap for air and steam,
a pressure gauge and a safety valve.
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Figure 9.6 Autoclave-overview
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Autoclave: Closed Chamber with High Temperature and Pressure
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Temperature (°C)
Time (min) Pressure (kPa)
121°C 30MIN 15LBS
126°C 10MIN 20LBS
131°C 30LBS 3 MIN
Uses of Autoclaves:
• Uses :1. Useful for
materials which can not withstand high temp.
2. To sterilize culture media, rubber material, gowns, dressings, gloves etc.
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Sterilisation controls:• Sterilisation controls:
1. Thermocouples2. Bacterial spores-
Bacillus stearothermophilus
3. Browne’s tube4. Autoclave tapes
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Filtration:• . Filtration:
• Useful for substances which get damaged by heat.
• To sterilize sera, sugars and antibiotic solutions.
• To obtain bacteria free filtrates of clinical samples.
• Purification of water.Wednesday, May 3, 2023
YaSh 59
FILTERS
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60YaSh
Filtration Sterilize solutions
that may be damaged or denatured by high temperatures or chemical agents.
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Candle filters
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CANDLE FILTERS Hollow ‘Candle’ form
Principle – Fluid is forced by suction or
pressure from the inside to outside or vice
versa.
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SINTERED GLASS FILTERS Made from finely ground glass fused
sufficiently to make small particles adhere
Cleaning – After use, they are washed with
running water in reverse direction and cleaned
with warm, strong sulphuric acid.
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64YaSh
The roles of HEPA filters in biological flow safety cabinets
Exhaust HEPAfilter
Blower
Supply HEPAfilter
Light
High-velocityair barrier
Safety glassviewscreen
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RADIATION
IONISINGNON-IONISING
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IONISING RADIATION• Lethal action – breakdown of single stranded
or sometimes double-stranded DNA and effect
on other vital cell components.
• Cold sterilisation.
• X-rays, gamma rays and beta rays
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NON-IONISING RADIATION
Electromagnetic rays with wavelengths
longer than those of visible light are used.
Ultraviolet and infrared rays
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68YaSh
Ultraviolet rays kills
microorganisms by
chemical reaction.
Low penetrating capacity
Infrared rays have no
penetrating capacity.
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69YaSh
CHEMICAL METHOD
• TWO TYPE LIQUID AND GAS• LIQUID
1. ALCOHOL2. PHENOLS3. HALOGENS4. OXIDANT5. SURFACTANTS
• GAS1. ETHYLENE OXIDE2. ALDEHYDES
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TRANSMISSION BASED PRECSUTION
• AIRBONE PRECAUTION• CONTACT PRECAUTION• DROPLET PRECAUTION• ENTERIC PRECAUTION
USE SPECIFIC STRATEGIES
VAPCRBSICAUTI
VAP (VENTILATOR-ASSOCIATED PNEUMONIA
)
INTUBATION •AVOID•ORAL•REINTUBATION•CUFF PRESSURE•USE SUBGLOTTIC SUCTION PORT ET TUBEVENTILATOR NONINVASIVE ROUTINE CHANGE OF CIRCUIT AVOID
SUCTIONCLOSE ENDOTRACHEAL SUCTIONING
CRBSI
•Prefer the upper extremity •If the catheter is inserted in a lower extremity site, replace to an upper extremity site as soon as possible
•Use maximal sterile barrier precautions •Clean skin with more than 0.5% chlorhexidine preparation with alcohol (usually 2% chlorhexidine with 70% w/v ethanol)
•Use ultrasound-guided insertion if technology and expertise are available
•dressing sterile transparent semipermeable Replace site dressing only when the dressing becomes damp, loosened, or visibly soiled
be changed frequently (every 72 h)
Evaluate the catheter insertionInsertion date should be put on all vascular access devices Use needleless intravascular catheter access systems and avoid stopcocks. Clean injection ports with an appropriate antiseptic Assess the need for the intravascular catheter daily and remove when not required Peripheral lines should not be replaced more frequently than 72-96 h.Replace administration sets, including secondary sets and add-on devices, every day in patients receiving blood, blood products, or fat emulsionsIf other intravenous fluids are used, change no <96-h intervals and at least every 7 days Needleless connectors should
CAUTI
•ENVIRONMENTAL FACTORS•High-quality cleaning and disinfection •EPA-registered disinfectants •Frequency of cleaning•The unit situated•Central air-conditioning systems WITH PROPER filters •It is recommended that all air should be filtered to 99% efficiency down to 5 μm
•Suitable and safe air quality must be maintained at all times. Air movement should always be from clean to dirty areas
•It is recommended to have a minimum of six total air changes per room per hour, with two air changes per hour composed of outside air
•Isolation facility should be with both negative- and positive-pressure ventilations
•Clearly demarcated routes of traffic flow through the ICU are required
•Adequate space around beds is ideally 2.5-3 m
•Electricity, air, vacuum outlets/connections should not hamper access around the bed
•Adequate number of washbasins should be installed
•Alcohol gel dispensers are required at the ICU entry, exits, every bed space and every workstation
•There should be separate medication preparation area
•separate areas for clean storage and soiled and waste storage and disposal
•Adequate toilet facilities should be provided
ORGANIZATIONAL AND ADMINISTRATIVE MEASURESpatient to nurse ratio Policies for controlling traffic flow to and from the unit to reduce sources of contamination from visitors, staff and equipmentWaste and sharp disposal policy Education and training for staff about prevention of nosocomial infections Protocols for prevention of nosocomial infections Audit and surveillance of infections and infection control practices Infection control team (multidisciplinary approach) Antibiotic stewardship Vaccination of health care personnel