Hospital acquired (nosocomial) infection by Mahboob ali khan CPHQ USA
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Transcript of Hospital acquired (nosocomial) infection by Mahboob ali khan CPHQ USA
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HOSPITAL ACQUIRED (NOSOCOMIAL) INFECTION
Mahboob Ali Khan MHA CPHQ USA Harvard
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DEFINITION:
ANY INFECTION ACQUIRED BY A PATIENT IN HOSPITAL.
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SOME STATISTICS:
• Affects approx. 10% of all in-patients • (KFHUrate the last 5 years 1.14%)• delays discharge • HAI costs 2times >no infection• direct cause deaths
Socio-economic burden of HAI
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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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Classification of surgical procedures
Cleanno entry into GI/GU/Resp tractlow riskinfection usually exogenous
Clean contaminatedno significant spillagee.g. cholecystectomy
infection rates 5-10 %
Contaminated Significant spillage of bacteria expected Infection rate 18-20%
DirtyPerforated viscus drainage of abscess Infection rate often >30%
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IMPORTANT CROSS-INFECTION ORGANISMS
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METHICILLIN RESISTANT STAPH AUREUS (MRSA)
Resistant to Flucoxacillin and usually others
May cause - Wound infection Bacteraemia Skin/soft tissue infection U.T.I. Pneumonia etc.
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Colonisation common:
Nose Axilla Perineum Wounds/Lesions
Spread By:
Hands Fomites Aerosols Becoming more common in the Community
Control:
Eradication of carriage Barrier nursing Screening of other patients Staff
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TUBERCULOSIS Open pulmonary TB (Sputum smear positive for AFB)
VIRAL INFECTIONS
Chicken Pox (Hepatitis B HIV)
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RESISTANT GRAM NEGATIVE ORGANISMS
Resistance to multiple antibiotics
Organisms:E .coli Proteus Enterobacter Acinetobacter Pseudomonas aeruginosa
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Cause: Bacteraemia U.T.I. Pneumonia Wound infection
Control: Antibiotic Policy Control of Infection Guidelines Prevention of Cross Infection especially on high risk areas
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SURVEILLANCE
Important means of monitoring HAI Early detection of trends outbreaks 1. Laboratory Based Microbiology Laboratory lists +ve organisms ICN reviews ‘Alert organisms’ reported 2. Ward Based Ward staff monitor patientsICN reviews ICN visits wards
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H.A.I. IS INCREASING: 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%
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Many Personnel Don’t Realize When
They Have Germs 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
Casewell MW et al. Br Med J 1977;2:1315Ojajarvi J J Hyg 1980;85:193
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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 contact
before invasive procedures
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Why
Don’t Staff Wash their Hands
(Compliance estimated at less than 50%)
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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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Why Not?• Working in high-risk areas
• Lack of hand hygiene promotion
• Lack of role model
• Lack of institutional priority
• Lack of sanction of non-compliers
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Successful Promotion • Education• Routine observation & feedback• Engineering controls
– Location of hand basins– Possible, easy & convenient– Alcohol-based hand rubs available
• Patient education(Improving Compliance with Hand Hygiene in Hospitals. Didier Pittet. Infection Control and Hospital Epidemiology. Vol. 21 No. 6 Page 381)
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Successful Promotion • Reminders in the workplace
• Promote and facilitate skin care
• Avoid understaffing and excessive workload; Nursing shortages have caused
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Hand Hygiene
Easy, timely access to both hand hygiene and skin protection is necessary for satisfactory hand hygiene.
A study by Pittet showed a 20% increase in compliance by using feedback and encouraging the use of alcohol hand rubs
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Hand Hygiene Techniques1. Alcohol hand rub
2. Routine hand wash 10-15 seconds
3. Aseptic procedures 1 minute
4. Surgical wash 3-5 minutes
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Repeat procedures until hands are clean
Routine Hand Wash
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Alcohol Hand Rubs
• Require less time
• Can be strategically placed
• Readily accessible
• Multiple sites
• All patient care areas
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Alcohol Hand Rubs• Acts faster
• Excellent bactericidal activity
• Less irritating (??)
• Sustained improvement
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Alcohol Hand RubsChoose agent carefully:
– Adequate antimicrobial efficacy
– Compatibility with other hand hygiene products
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Visible soiling
Hands that are visibly soiled or potentially grossly contaminated with dirt or organic material MUST by washed with liquid soap and water
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Areas Most Frequently Missed
HAHS © 1999
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Hand Care• Nails
• Rings
• Hand creams
• Cuts & abrasions
• “Chapping”
• Skin Problems
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Hand hygiene is the simplest, most effective measure for preventing
hospital-acquired infections.
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PREVENTING CROSS INFECTION
If known or suspected on admission to hospital, or detected following admission:
- Isolation (barrier precautions) - Inform Infection Control team - Treatment - if appropriate - Regular surveillance
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Any Questions???
• Thank you for not asking!!!
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tHanK YoU fOr yoUr cOopeRatiOn and UnTiriNg sUPpoRt