PREVENTION OF HOSPITAL AQUIRED INFECTION

Presented By:

Dr.P.P.Singh

Ex.MEDICAL SUPRINTENDENT HRH &SDN HOSPITAL

Ex.Director Project IPP-VIII

Municipal Corporation of Delhi

Dr. P.P.SINGH

Dr. P.P.SINGH

1. CSSM 3. CARE OF WOMEN

FOR RTI/STI(AIDS)

2. FAMILY PLANING

4. ADOLESCENT HEALTH

RCH

WHOLESTIC LIFECYCLE APPROACH TO

WOMEN HEALTH

Dr. P.P.SINGH

Definition

• Infection acquired by the patients from hospital facilities i.e.

- during hospitalisation

- due to any therapeutic / diagnostic procedures

Dr. P.P.SINGH

Sources of Hospital Infections

• Cross Infection

• Self or auto infections

• Environmental

Dr. P.P.SINGH

Prevalence of Hospital Acquired Infection • In early seventies Barrett Connor

Estimated 3-13%• Estimate in USA

Around 1.5 million cases of 5-20% and operative infections 4.7 to 21.8% with an average of 9.7%

• WHO

Estimated after study in 47 countries 3-21% with mean of 8.4%

• India

Authenticated data not available.

References of few hospitals indicate around 10%

Dr. P.P.SINGH

Aetiology• Like any other disease Process Hospital Infection has

also got epidemiological triad i.e. the agent, host and environment

• Entire spectrum of microbes i.e. bacteria, viruses, ricketsis, fungi and protozae etc. responsible for hospital infection

• 20-25% of all Hospital Infections due to Gram +ve Organisms

• Proteous, e-coli, salmonella, klebsiella, pseudomonas are on the rise

cont.

Dr. P.P.SINGH

Risk Factors

• Patient factors:• Extreme age

• Malnutrition

• Immune deficiency

• Injuries

• Diseases like Diabetes, Nephritis, Severe burns

• Endogenous infection

cont.

Dr. P.P.SINGH

• Microbial factors:•High conc. Of agent

•High level of virulence

•Emergence of resistant strains

•Presence of new organism

• Environmental factors:•Level of contamination

•Medical interventions

Dr. P.P.SINGH

Pathogenic Organisms • Gram Positive

– Staphylococcus

– Streptococcus

– B.subtalis

• Gram Negative– E.coli

– Pseudomonas

– Proteus

– Klebsiella

– Citrobacter

– Shigella

– Salmonella

– Serratia

• Virus– Hepatitis A,B,C…

– HIV/AIDS

– Dengue

– Japanese encephelitis

• Rickettesial– Typhus

– Scrub fever

• Protozoal– Malaria

– Amoebiasis

• Mycobacterial– Tuberculosis

Dr. P.P.SINGH

Modes of transmission

• Contact spread– Contaminated inanimate objects

• catheters• Cystoscopes• Bed pans etc.

– Person to person & Droplet infection• Infective Hepatitis

• Streptococcal Pharyngitis

Cont.

Dr. P.P.SINGH

• Common Vehicle Spread– Transmission through food

• Salmonella

– through blood and blood products & Injections and intravenous fluids • Hepatitis B & C

• HIV / AIDS

• Gram -ve Septicemia

• Salmonellosis

Cont.

Dr. P.P.SINGH

• Airborne spread– Vaccum cleaners & Dust Particles

• Staphalococcal infection

• Tuberculosis

Dr. P.P.SINGH

• Vector Borne Spread– Body parts of vectors like

• Mosquitoes

• Flies

• Flea

• Bugs

• Cockroaches

Transmit Infections like» Gastroenteritis

» Yersina pestis

» Malaria

» Dengue

Dr. P.P.SINGH

Types of Hospital Acquired Infection• Urinary tract infections

• Lower respiratory tract infections

• Surgical wound infections

• Anaerobic bacteriological infections

• Gastroenteritis

• Transplant associated infections

• Intravenous cannula related infections

• Intracardiac & various prosthesis infections

• Perpureal infections

Dr. P.P.SINGH

High Risk Procedures for HAI

• Injections

• Surgical Procedures

• Dressing of wounds

• Management of deliveries

• Investigative procedures

• Laboratory investigations

• Dialysis

Dr. P.P.SINGH

High Risk Areas for HAI• Haemodialysis Unit

• Intensive Care Unit

• Nursery Unit

• Pharmacy

• Dietetics services

• Laundry

• Operation Theatre

• O.P.D.

Dr. P.P.SINGH

Management of HAI• HAI Control Committee (meeting once a month)

– Chairman - Medical Superintendence– Member Secretary - Infection Control Officer

(Microbiologist)– Members - Head of all clinical units

- Chief of blood bank- Microbiologist- Medical record officer- Chief of nursing services- Infection control sister

– Invited Members - Chiefs of all supportive services Cont.

Dr. P.P.SINGH

• Surveillance of HAI

• Sterilisation and high level disinfection

• Proper discarding and disposal of hospital waste

• Universal blood and body fluid precautions by health care workers

• Dietetics services

• Laundry

• Antibiotic policy

• In-service training

Dr. P.P.SINGH

Universal Precautions• Wash hands before and after patient contact

• Wear gloves for contact with blood & body fluids

• Wear masks to protect against aerosols & splashes

• Wear gowns to protect against splashes

• Handle and dispose sharps safely

• Disinfect and sterilise critical items

• safe disposal of waste

• Hepatitis B vaccination

Dr. P.P.SINGH

Safe Handling & Disposal of Sharps

• Always dispose of your own sharps

• Never pass sharps directly from one person to other

• The risk of injury in high risk areas should be minimised by ensuring best possible visibility for operator

• Protect fingers from injuries by using forceps while suturing

• Locate sharps disposable container close to the point of use

Dr. P.P.SINGH

Infection Control Indicator Checklist• Handle sharps safely to minimise injury

– Appropriate puncture proof sharps container– Container less than three quarter full– Sharps not protruding from container– No recapping or one hand recapping of needle & syringe

• Instrument decontaminated fully– Steriliser available and in good working order– Equipment thoroughly cleaned after use– Clean instruments stored in cupboards

Dr. P.P.SINGH

• Hands washed appropriately to prevent cross infection– Soap and clean water available– Clean towels available– Staff wash & dry hands after contact with body fluid, removal

of gloves and contact with patients

• Protective barrier worn to prevent blood exposure Depending on the clinical area and risk of exposure use

• Disposable gloves

• Heavy duty gloves

• Masks

• Aprons

• Protective eye wears

Dr. P.P.SINGH

• Waste disposal safety– Evidence of deep burial or incineration regularly– No contaminated waste visible

Dr. P.P.SINGH

Cost related to HAI• The outbreak infections are expansive. The cost

increased can be summarised as – Prolonged patient stay– Increase consumption of disinfectants– Increase use of protective clothing– Increase in overhead expanses– Cost associated with patient screening– Need for expansive antibiotic therapy

Dr. P.P.SINGH

HIV / AIDS

PROBLEM IN DELHI. 35000 HIV +Ve.

780AIDS Cases.

PROBABLE SOURCE

•HETRO SEXUAL 75%

•INJECTABLES 7.3%

•RECIPIENT OF BLOOD 7.5%

•OTHER 11%

Dr. P.P.SINGH

AWERNESS A ACQUIRED ADULT HOOD(Education)

INFORMATION I IMMUNO INJECTABLES

DRUGS(PRE) D DEFFICENCY DRUGS(Disinfectants)

SAFE SEX S SYNDROME SEX

Dr. P.P.SINGH

RNA Virus

Reverse transcription

HIV1 &HIV2

Dr. P.P.SINGH

Common cold 5 – 15 years

Death

6-8 wks

Anti bodies

Dr. P.P.SINGH

RISKS.

Needle stick/prick injury--- 0.25 to 0.3% for HIV, 9 to 30% for HBV, 3-10% for HCV

0.3% risk through muco -cutanious exposure

0.6% IN NON SURGICAL.

4% IN SURGICAL, HIGER IN GYNAECOLOGIST

5 / 1000 IN OTHERS

40% WHILE SUTURING.

60% RECAPPING.

Dr. P.P.SINGH

ANTISEPTICS

HIV1&2 Hp B

H2O2 0.3 3 %

ALCOHOL 50% 95%

FORMALINE 0.5% 1%

LYSOL 2% 3%

BLEACH 1% 5%

GLUTERALDEHYDE 2% 2%

ULTRA VIOLET LIGHT- HIGHER DOSE

LAMINAR FLOW, OT, LAB.

DRYCLEANNING MAY NOT INACTIVATE

Dr. P.P.SINGH

MISCONCEPTIONS

MOSQUITO BITE

ANY INSECT BITE

CASUAL CONTACT WITH AIDS pt.

WITH IN HOUSE HOLD

SHARING FOOD, WATER, CLOTHS OR TOILETS

PROFESSIONAL CONTACT.

Dr. P.P.SINGH

METHODS OF PREVENTION AMONGST HEALTH PERSONNEL

1. KNOWLEDGE, ATTITUDE,PRACTICE. Barrier precautions, Aseptic precautions Management of parenteral &MM exposure to blood/blood products, tissue

organs.2. HAND WASHING WITH SOAP 10 -15 SECONDS 3. WEAR GLOVES – BOTH HANDS, WASHING HAND AFTER

REMOVING GLOVES.4. WEAR EYE GLASSES, FACE SHIELD ,APRON /GOWANS5. DECONTAMINATION / DISINFECTING –

INSTRUMENTS,GLOVES,LINEN ALL THINGS WITH BLEACHING POWDER -15 gms /liter.- SURFACE – 10% BLEACH

5. BIO MEDICAL WASTE ( BMW).6. P.E.P.

Dr. P.P.SINGH

• SALIVA as source.

- Mouth piece.

- Resuscitation Bags

-Ventilation devices

- Suction machines

-Mouth to Mouth Breathing

• HOSPITAL DISINFECTANT- Chlorine – 1-1.5%

Sod. Hypochlorite 1 gm/L

Calcium hypochlorite 1.4 gm/L

Bleach at least 10 min.

Dr. P.P.SINGH

HANDLING SPECIMENSUSE GLOVES

SCREW CAPPED LEAK PRFOOF CONTAINERS

CARE TAKEN WHILE TRANSPORT OF SAMPLES.

SERA CAN BE KEPT - - HEAT 56 0 C FOR 30 MIN.

NO MOUTH PIPETTINGS

ANY SPILLAGE OF BLOOD & OTHER BODY FLUIEDS ON TABLE TOP OR ANY SURFACE – CLEAN WITH SOD. HYPOCHLORITE.

ALL OPEN WOUNDS ON HAND & ARMS SHUOLD BE COVERED

Dr. P.P.SINGH

ASEPTIC PRECAUTIONS

(IN RELATION TO INJECTION / OTHER SKIN PIERCING

PROCEDURES)

REDUCE UNECESSARY USE.

SINGLE USE DISPOABLES

REUASBLE SHOULD BE DIS INFECTED ,WASHED , & STERILISE

PUNCTURE PROOF CONTAINERS

P E P – ANY NEEDLE STICK , INJURY , CUTS OR MUCUS MEMBRAIN EXPOSURE.

- WASH PROPERLY

- BLEEDING IS ENCOURAGED

Dr. P.P.SINGH

NON INVASIVE PROCEDURES

VAGINAL & RECTAL EXAMINATION.

INTRA OCCULAR PRESSURE

CONTACT LENSES TRIAL.

TRACHIAL & LARYNGIAL EX.

THROAT & NASAL EX.

X RAY & CT SAN ETC,

- THERE IS CHANCES OF BREAK OF MM.

- BODY FLUIDS / SECRETION MAY ACT AS SOURCE OF INFECTION.

*** EFFECTIVE USE OF STERILISATION & DISINFECTANTS

Dr. P.P.SINGH

Conclusion• Prevention of Hospital Infection will cut the wasteful

expenditure. Savings could be re-deployed for betterment of hospital

• Incidence of Hospital Acquired Infection can be reduced to great extent by– Work culture & attitude of health care providers– Religious observation of universal precautions– Application of antiseptic technique– Proper Disposal of hospital waste