Hospital infection control
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Transcript of Hospital infection control
Hospital Associated Infections & Control
Deptt of Microbiology, Surgery, Anaesthesiologyand critical care UCMS & GTBH
Go Gators!
Nosocomial infections/ HAINosocomial infections/ HAI
Nosocomial infectionsNosocomial infections are infections are infections which are a result of treatment in a hospital which are a result of treatment in a hospital or a healthcare service unit, but secondary or a healthcare service unit, but secondary to the patient's original condition. to the patient's original condition.
Infections are considered nosocomial if they Infections are considered nosocomial if they first appear 48 hours or more after hospital first appear 48 hours or more after hospital admission or within 30 days after discharge.admission or within 30 days after discharge.
PathophysiologyPathophysiology
Within hours of admission, colonies of hospital strains of bacteria develop in the patient's skin, respiratory tract, and genitourinary tract.
Interaction between the contaminating organism and the host.
Not all colonized individuals develop infection .
Persons who have progressed from colonization to infection may represent only the “tip of iceberg” of persons carrying a particular pathogen.
Consequences of Hospital Associated
Infections
Complicate TreatmentCause Additional SufferingIncreased Costs ($4.5
billion/ yr) prolonged hospital stay drug treatment additional surgery
Cause Death
PathophysiologyPathophysiology
Within hours of admission, colonies of hospital strains of bacteria develop in the patient's skin, respiratory tract, and genitourinary tract.
Interaction between the contaminating organism and the host.
Not all colonized individuals develop infection .
Persons who have progressed from colonization to infection may represent only the “tip of iceberg” of persons carrying a particular pathogen.
Classification of Nosocomial Infections Classification of Nosocomial Infections (based on)(based on)
1.1. Source of micro-organismsSource of micro-organisms
2.2. Type of infectionsType of infections
Source of micro-organismsSource of micro-organisms
Endogenous infections Endogenous infections
eg: eg: Klebsiella, E.coliKlebsiella, E.coli
Exogenous infections Exogenous infections
eg: eg: PseudomonasPseudomonas
Type of infectionsType of infections
1.1. Catheter related blood stream infections Catheter related blood stream infections (CR-BSI)(CR-BSI)
2.2. Urinary tract infections Urinary tract infections (UTI)(UTI)
3.3. Ventilator related pneumonia Ventilator related pneumonia (VAP)(VAP)
4.4. Surgical site infections Surgical site infections (SSI)(SSI)
5.5. Burns infectionsBurns infections
Factors
EnvironmentMicrobesHost characteristicsIndwelling devices
Hospital EnvironmentBuildingAirWaterKitchen and food handlingMedical wasteLaundry
High Risk AreasHigh Risk Areas
Nurseries Intensive care unitDialysis unit Organ transplant
Unit
Burns wardCancer wardOperation theatrePost operative
ward
Agent related factorsAgent related factors
Virulence of the organism (S.aureus, Pseudomonas).
Antimicrobial resistance: highly influenced by usage patterns.
Resiliency: Ability to survive in the environment.
Resistance to disinfectants.
MicrobalMicrobal agents:agents:
Bacteria
Viruses
Parasites
Fungus
MRSA/VRSA
VRE
MDR Acinetobacter
MDR Pseudomonas
ESBL K. pneumo
Common bacterial nosocomial infections Common bacterial nosocomial infections causing bloodstream infectionscausing bloodstream infections
Nosocomial UTINosocomial UTI
E. coliE. coli KlebsiellaKlebsiella PseudomonasPseudomonas Entero cocciEntero cocci Candida albicansCandida albicans
Nosocomial PneumoniaNosocomial Pneumonia
Pseudomonas aeruginosaPseudomonas aeruginosa Klebsiella sppKlebsiella spp Staph aureusStaph aureus AcinetobacterAcinetobacter LegionellaLegionella AspergillusAspergillus CandidaCandida Mycoplasma pneumoniaeMycoplasma pneumoniae Chlamydia pneumoniaeChlamydia pneumoniae
Nosocomial SSINosocomial SSI
Staph aureusStaph aureus PseudomonadsPseudomonads CoNSCoNS Gram negative rodsGram negative rods EnterococciEnterococci
Nosocomial VirusesNosocomial Viruses
Hepatitis B & CHepatitis B & C RSVRSV Rotavirus Rotavirus Enterovirus Enterovirus CMVCMV HIVHIV Ebola Ebola Influenza virusInfluenza virus HSV HSV VZVVZV
Nosocomial Parasite & FungiNosocomial Parasite & Fungi
Giardia lambliaGiardia lamblia Cryptosporidium Cryptosporidium Sarcopties scabeiiSarcopties scabeii Candida albicansCandida albicans Aspergillus spp.Aspergillus spp. Cryptococcus neoformansCryptococcus neoformans
Host Characteristics:Influence susceptibility and
severity of disease
Age Socioeconomic status
Disease historyLife styleNutritional statusImmunization
U nfortunate 5%
Patients at high risk for NI Transplant patients
Chemotherapy patients
Other I mmunocompromisedpatients
Diagnostic and therapeutic Diagnostic and therapeutic interventionsinterventions
Foley Catheters
Ventilators
Other tubes
IVs/CVLs
Implants
Transmission of Nosocomial Infections
Patient to patient
Patient to healthcare worker
Healthcare worker to patient
CHAIN OF INFECTIONCHAIN OF INFECTION
SOURCESOURCEHOSTHOST
PATIENT
EMPLOYEE
ENVIRONMENT
EQUIPMENT
VISITORSVISITORS
Method of Transmission
Direct Indirect
AGEAGE
Nutrition
Socioeconomics
DISEASE
Immunity
Skin Injury
Treatment
Life Style
VehicleVector
MAGNITUDE OF PROBLEMMAGNITUDE OF PROBLEM
WHO: Eastern Mediterranean Region
(11.8%)
South-East Asia, (10%).
At any time over 1.4 million people worldwide suffer from hospital infections
Cost more than US$ 40 million every year in Thailand alone.
In our hospital ????
Our Experience in GTBHOur Experience in GTBH
Emergence of Multidrug resistant Acinetobacter in Burns unit
(1993-1997-1%-1997-2002-9.5%)
Increased prevalence of Kpneumoniae harbouring ESBL (87%)
NICU: Clinical and environmental ESBL K.pneumoniae
Increase in MRSA isolation(40-60%)
Increase in concomitant HLAG resistance in Enterococci (61%)
Infection Control:Basic Elements
The Infection Control Team
Hospital EpidemiologistInfection Control Committee
ChairmanInfection Control DirectorInfection Control PractitionersGTB Healthcare Staff
YOU!!
Infection Control is E veryone’s Business
Fam ily/ V isitors
C N A /P C A /C M A
Reduce transmission of infectious diseases in the health care setting
Improve quality of health care services through promotion of infection control
Goals of Infection control
Prevention
Reduce person to person transmission of organisms
Prevent transmission from environment
Appropriate use of antimicrobials, nutrition and vaccination
Limit invasive procedures to prevent endogenous infections
Prevention
Surveillance of infections, identifying and controlling outbreaks
Prevention of infection in staff members
Enhancing staff patient care practices and continuing staff education
Standard Precautions
Designed to reduce risk of transmission of pathogens
Apply to all patients Apply to:
blood (including plasma, platelets, serosanguinous fluids, and medications derived from blood such as immune globulins, albumin, and factor VIII and IX)
All body fluids, excretions, secretions - - regardless of visible presence of blood
Standard Precautions (cont’d)
HandwashingPersonal protective equipmentsSafe handling of sharpsSafe handling of blood and body
fluid spillsUse of sterile instrumentsControl of hospital waste
Proper handwashing is VITAL to infection prevention
Before patient contact After contact with anything contaminated Between contact with different patients During patient care (per procedures)
before and after invasive procedurebefore and after contact with woundbetween procedures on different body parts of the
same patientBetween glove changesImmediately, if skin is contaminated or an injury
occurs
Wash Your Hands!!Wash Your Hands!!
Studies have shown that healthcare worker compliance with handwashing recommendations is 42% ---- What is your percentage?
WASH YOUR HANDS
It has also been reported that even when healthcare workers do wash their hands, they do not
always use proper technique.
How should I wash my hands?
For general patient care wash hands thoroughly with soap in running water without missing any area.
For high risk patients use hospital-approved antimicrobial soap.(2-4% chlorhexidine gluconate / detergent solution)
For surgical scrub scrub for 3-5 minutes
.
Personal Protective Equipment (PPE)
GlovesGownProtective Eye
and Face ShieldMasksOthers
Boots, shoe covers CPR shield
B E C A R E F U L W I T H S H A R P S
D o n o t r e c a p b y h a n d U s e o n e - h a n d t e c h n i q u e o r a r e c a p p i n g
d e v i c e - - o n l y i f r e c a p p i n g i s u n a v o i d a b l e .
D o n ' t b e n d , b r e a k o r r e m o v e n e e d l e s f r o m s y r i n g e .
D i s p o s e y o u r o w n s h a r p s i n s h a r p s c o n t a i n e r
R e p l a c e s h a r p s c o n t a i n e r s w h e n 3 / 4 f u l l
Safe handling of Blood /Body fluid spills
•Cover spill with paper towel/ blotting paper/newspaper
•Pour 1% sodium hypochlorite solution on and around for minimum 30 min
•Remove with brush and discard
Key Points for Cleaning, Sterilisation& Disinfection of Patient Care Equipment/
Environmental Surfaces
Firstremove gross debris and organic matter by cleaning
Recommendations for sterilisationand disinfectionof patient care equipments and environmental surfacesw3.whosea.org/bct/pdf/HLM-343.pdf
Heat is the best sterilant Only use disinfectants approved by Hospital
Be sure to follow the manufacturer’s directions for use on the container’s label
Bleach is the cheapest & best disinfectant For 1:10 dilution: make fresh daily For 1:5 dilution: use for 30 days
Commonly used disinfectantsCommonly used disinfectants Skin Disinfection (Antiseptic):Skin Disinfection (Antiseptic):Isopropyl alcohol (70-80%)Isopropyl alcohol (70-80%)Halogens (iodine, iodophores)Halogens (iodine, iodophores)Quarternary ammonium compounds (cetrimide)Quarternary ammonium compounds (cetrimide)Biguanides (chlorhexidine)Biguanides (chlorhexidine)Phenolics (hexachlorophene, choroxylenols like Phenolics (hexachlorophene, choroxylenols like
dettol)dettol)Savlon (cetrimide + chlorhexidine)Savlon (cetrimide + chlorhexidine) Heat sensitive instruments:Heat sensitive instruments: Glutaraldehyde 2%, hydrogen peroxide 6%Glutaraldehyde 2%, hydrogen peroxide 6%
Environmental DisinfectionEnvironmental Disinfection
Clean surfacesClean surfacesEthyl alcohol (70%) is good for trolley top and Ethyl alcohol (70%) is good for trolley top and
thermometers.thermometers.Hypochlorite for surfaces with blood spills, viruses, Hypochlorite for surfaces with blood spills, viruses,
food preparation surfaces.food preparation surfaces. Dirty surfaces Dirty surfaces Phenolics (Lysol)Phenolics (Lysol)Sodium hypochloriteSodium hypochlorite
BacteriologicalMonitoring Bacteriological testing of the environment is not
recommended except in selected circumstances
such as:
epidemic investigation where there is a suspected environmental source
dialysis water monitoring for bacterial counts
quality control when changing cleaning practices.
Isolationand containment (in addition to Standard Universal Precautions)
Airborne precautions: droplet nuclei <5 µm e.g.tuberculosis, chickenpox, measles
requires negative air pressure room
Droplet precautions: droplet nuclei >5 µm e.g. bacterial meningitis, diphtheria, respiratorysyncytial virus
Contact precautions: enteric infections diarrhoea , skin lesions
Strict isolation:haemorrhagic fever, SARS
Biohazardous
vs.
Regular
Waste Management
Red Bag(Cat 3,4,7)
All plastic waste (infected andnoninfected)SyringesUsed blood bagUrinary bag, cathetersEmpty plastic containersIV setsEmptyglucose bottlesSurgical glovesSharps: collect in puncture proof containers
Y ellow Bag(Cat 1,2,3,5,6)
soiled wasteCotton dressingPlastic castMaterial contaminatd with blood, body fluidsOutdated discarded medicines Human and animal tissue Body partswhole bloodPlacenta, pus
Black Bag(Cat9,10)
MCD wasteCard boardsPlastics after autoclaveAsh of Biomedical wasteWrappers of Biomedical waste
Report These Conditions To Occupational Health
“Weeping” dermatitis and draining lesions
“Pink eye”/conjunctivitisRash (no known reason)Fever/nausea/vomiting/diarrhea
Blood/body fluid exposuresfor post exposure prophylaxis
Other infectious disease exposures
IMMUNIZATIONSIMMUNIZATIONS
Required:MMRHepatitis B Recommended:Hepatitis AInfluenza
What should I do if an What should I do if an exposure occursexposure occurs?
Thoroughly wash exposed areaContact supervisor/access Occupational Health
Specific postexposurepoliciesHIV, hepatitis A virus, hepatitis B virus, hepatitis C virus, N.meningitidis, M.tuberculosis,VZvirus, hepatitis E virus, C.diphtheriae, B.pertussis, and Rabies
Antibiotic UseAntibiotic Use
Justify antibiotic use
clinical diagnosis
expected infecting microorganisms.
sensitivity pattern, patient tolerance and cost.
Select a narrow spectrum agent as far as possible
Avoid antibiotic combinations if possible.
SurviellanceSurviellance
Site oriented: Ventilator associated pneumonia, surgical site infections, blood stream infections, infections with MDR bacteria
Unit oriented: for high risk units, eg. Burns, ICU, etc.
Priority oriented: For specific issues,eg. UTI in catheterized patients
Training and capacity building Training and capacity building Training MethodologyTraining Methodology
Combination of:Combination of:– LecturesLectures– Practical exercisesPractical exercises– 5 month course5 month course– Series of five 1-week Series of five 1-week
coursescourses– Practical applicationPractical application
Remember:Remember: everything you touch everything you touch has been touched by someone elsehas been touched by someone else
Thanks for washing your hands
Any Questions?????
Talk to your supervisor
Contact Infection Control committee