Infection Control of

Healthcare Associated Infection

Boerhan Hidayat
Infection control committee
Dr.Soetomo General Hospital
Surabaya
What are hospital infections?
Two types of infections you
find in the hospital
Hospital-acquired infections
Community-acquired infections
How can we distinguish
them?
By latency period
CDC definition for NIs:
development of infections
after 48 hours of admission
What kinds of hospital infections exit?
Device-related
Blood stream infections (BSI)
Urinary tract infections (UTI)
Ventilator-associated pneumonia (VAP)
Procedure-related
Surgical site infections (SSI)
Environmental contamination
Water, disinfectant, etc.
Why do we need to study hospital
infections?
Not all hospital infections are
preventable, but they are associated
with
Excess length of hospital stay
Excess cost
Excess mortality
Law suits
Distribution of hospital infections by sites,
SENIC study
Increases in the mean length of hospital stay due to
hospital infections
in the U.S. , SENIC study
Excess cost of hospitalization due to hospital
infections in the U.S., 1992
Who are at risk for acquiring hospital
infections?
Patients in Intensive Care Units
ICU medical, surgical, burn, Neonatal
ICUPediatric ICU)
Surgery department
Immunocompromised patients
Cancer treatment, transplant, HIV
infections
Other factors
Age, smoking, chronic diseases
Distribution of hospital infections by infection
sites and endemic/outbreak status
Endemic
Outbreak
Nosocomial Pathogens By Infection Type
Pneumonia UTI BSI SSI
S. Aureus
19% 2% 16% 20%
Coag (-) staph
2% 4% 31% 14%
Enterococcus
2% 16% 9% 12%
Pseudomonas
17% 11% 3% 8%
Other gram (-)
29% 45% 17% 23%
C. albicans
<5% 8% 5% 3%
Jernigan, J. Cecils Textbook of Medicine
11
Host
Agents
Environment
Infection control
Nutrition
Vaccination
Hand washing
IPD
Environm. manag
(Biol & Non-Biol)
Waste
Aseptic
Antibiotics
Eradication
Key Prevention Strategies
Prevent infection
Diagnose and treat
infection effectively
Use antimicrobials
wisely
Prevent transmission
Clinicians hold the solution!
TYPES BY ORIGIN
1.Endogenous:
Caused by the organisms that are present
as part of normal flora of the patient
2. Exogenous:
Caused by organisms acquiring by exposure
to hospital personnel, medical devices or
hospital environment
Chain of Infection
+
Quantity of
pathogen
Virulence Route of
transmission
Sensitive
host
Port
Transmission Of Infectious Agents In All Settings
Requires 3 Interrelated Elements
Source
Mode of
Transmission
Susceptible
Host
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MIKROORGANISM (AGENT)
BACTERIA
VIRUSES
FUNGI
PARASIT
RICKETTSIA
PROTOZOA
PATHOGENESITY
VIRULENCE
INVASION
NUMBER
Flora:
Transient
Resident
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VIRULENCE
SEVERITY OF DISEASES
MORBIDITY
MORTALITY
TRANSMISSION LEVEL
INVASIVE ORGANISM
INTACT TISSUE
(SKIN, MUCOSE, ECT)
NUMBER OF BACTERIA
Epidemiologically Important Organisms
Antibiotic-resistant organisms such as
methicillin-resistant Staphylococcus
aureus (MRSA), vancomycin-resistant
Enterococcus (VRE), and multidrug-
resistant gram-negative bacilli are
being isolated with increasing
frequency*
Clostridium difficile has been
increasing in many US hospitals
*
NNIS Report 1992-2000. Am J Infect Control 2000;28:429.
S. aureus
Penicillin
[1950s]
Penicillin-resistant
S. aureus
Evolution of Drug Resistance in
S. aureus
Link to: CDC Facts about VISA Link to: CDC Facts about VRE
Methicillin
[1970s]
Methicillin-resistant
S. aureus (MRSA)
Vancomycin-resistant
enterococci (VRE)
Vancomycin
[1990s]
[1997]
Vancomycin
intermediate-
resistant
S. aureus
(VISA)
[ 2002 ]
Vancomycin-
resistant
S. aureus
Link to: MMWR on VRSA
Pandemic MRSA clones
UK (42%)
Australia
(30%)
Latin
America
(29%)
USA
(36%)
Africa
Nigeria (21%)
Zimbabwe (43%)
South Africa (49%)
Taiwan (61%)
Japan (74%)
Denmark/Norwegian
Netherlands (<1%)
Singapore (63%)
Hong
Kong (80%)
China (39%)
Europe (1-60%; 24%)
Canada (2%)
India (34%)
Brazilian clone
Iberian clone
Paediatric clone
Hungarian clone
New York/Tokio clone
Vancomycin-resistant Enterococci
Nosocomial Isolates in Europe
Nosocomial Isolates in the USA
New Resistant Bacteria
Emergence of Antimicrobial
Resistance
Susceptible Bacteria
Resistant Bacteria
Resistance Gene Transfer
Resistant Strains
Rare
Resistant Strains
Dominant
Antimicrobial
Exposure
Selection for antimicrobial-
resistant Strains
Antimicrobial Resistance:
Key Prevention Strategies
Optimize
Use
Prevent
Transmission
Prevent
Infection
Effective
Diagnosis
& Treatment
Pathogen
Antimicrobial-Resistant Pathogen
Antimicrobial
Resistance
Antimicrobial Use
Infection
Susceptible Pathogen
Transmission of Infectious Agents in Healthcare
Settings
Individuals are exposed to human sources of
microorganisms by three primary routes:
Contact transmission
Direct organism is transferred directly from one person to
another, e.g. scabies or herpetic whitlow
Indirect- organism is transferred through contaminated
intermediate object or person, e.g. hands or contaminated
patient care equipment
Droplet Transmission- relatively large ( >5 microns) droplet
heavy with moisture that are propelled relatively short distances
from the source (3-6 feet) onto the mucous membranes of the nose,
mouth or eyes, of the host and environmental surfaces
Airborne Transmission- droplet nuclei (<5 microns) that
remain suspended in the air for long periods, that may be inhaled
by the host into the alveoli of lungs
Routes of Transmission
Respiratory
Cough
Sneeze
Fecal-oral
Feces contaminate food, environment, or
hands
Vector-borne
Transmitted by insects
Transmission of Influenza Viruses
Seasonal
Influenza in
Humans
Current Avian
Influenza in Humans
Droplet
most likely
route
possible
Airborne
possible at
close distances
possible at close
distances
Contact
possible Most likely
(bird to human), and
possible (human to
human)
Chain Model of Infectious Disease
Control Points
Respiratory
Hygiene/Cough Etiquette
Education
Cover coughs, using tissue
or surgical mask
Hand hygiene
Spatial separation
Standard precautions
Handwashing
Personal Protective
Equipment
Standard Precautions
(continued)
Patient Placement
Safe work practices
Medical waste handling
Environmental cleaning and
disinfection
Expanded precautions:
- Contact
- Droplet
- Airborne infection isolation
- Empiric
Interrupt TRANSMISSION In Healthcare
(Including Home And Community Treatment) Settings:
There are two conditions that are not
infections:
1) Colonization, which is the presence of
microorganisms (on skin, mucous
membranes, in open wounds or in
execretions or secretions) that are not
causing clinical signs or symptoms. .
2) Inflammation, which is a condition that
results from tissue response to injury or
stimulation by noninfectious agents
such as chemicals.
Goals for infection control and hospital
epidemiology
There are three principal goals for hospital
infection control and prevention
programs:
1. Protect the patients
2. Protect the health care workers, visitors,
and others in the healthcare environment.
3. Accomplish the previous two goals in a
cost effective and cost efficient manner,
whenever possible.
.
Main Task of Infection
Control Committee
Develop policies
Training and
educations
Advocacy
Surveilance
Reporting and
recommendation
32
INFECTION
CONTROL
For the management
and
Departments concerned
33
Problems Identification
&
Risk Factors
Analyse
Recommendation
Monitoring & Evaluation
Implementation
Surveillance
Reporting
Evaluation
Advocacy
&
Quality
Control
Advocacy
&
Quality
Control
Working Capacity
Of ICC
Conclusions
Infection control is very essential to
reduce the HAI
Not all HAI can be prevented, but they
are associate with LOS, cost, mortality and
law suit
Infectious Disease Control Points
Contain the source
Interrupt transmission
Reduced susceptibility of the host