HOSPITAL INFECTIONS

FACTS, CONCERNS, AND PREVENTION

Dr.T.V.Rao MD

DR.T.V.RAO MD

NOSOCOMIAL INFECTIONS
Nosocomial

comes from the Greek word nosokomeion meaning hospital (nosos = disease, komeo = to take care of). This type of infection is also known as a hospital-acquired infection (or more generically healthcare-associated infections
2

DR.T.V.RAO MD

WHAT ARE HOSPITAL ACQUIRED INFECTIONS

An infection acquired in hospital by a patient

who was admitted for a reason other than that infection . An infection occurring in a patient in a hospital or other health care facility in whom the infection was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among

staff of the facility

DR.T.V.RAO MD

NOSOCOMIAL INFECTIONS ON PUBLIC HEALTH

Nosocomial infections are widespread. They are important contributors to morbidity and mortality. They will become even more important as a public health problem with increasing economic and human impact

DR.T.V.RAO MD

CROWDING A MAJOR FACTOR

Increasing numbers

and crowding of people. More frequent impaired immunity (age, illness, treatments). New microorganisms.

DR.T.V.RAO MD

Increasing bacterial resistance to antibiotics contributed as emerging problem

WHEN THE NOSOCOMIAL INFECTIONS MANIFEST

Majority of such infections

become evident during their stay in the Hospital or some times only after their discharge from the patient.
DR.T.V.RAO MD

HOW AND WHEN HOSPITAL ACQUIRED INFECTIONS OCCUR. Nosocomial infections are infections which are a result of treatment in a hospital or a healthcare service unit, but secondary to the patient's original condition. Infections are considered Nosocomial if they first appear 48 hours or more after hospital admission or within 30 days after discharge.
DR.T.V.RAO MD

COMMONLY OCCURRING MICROORGANISMS IN HOSPITAL INFECTIONS

DR.T.V.RAO MD

MICROORGANISMS AND NOSOCOMIAL INFECTIONS

DR.T.V.RAO MD

The patient is exposed to a variety of microorganisms during hospitalization. Contact between the patient and a microorganisms does not by itself necessarily result in the development of clinical disease other factors influence the nature

URINARY TRACT INFECTIONS

Escherichia coli Klebsiella,

Serratia,Proteus spp Pseudomonas aeruginosa Enterococcus spp Candida albicans

DR.T.V.RAO MD

10

RESPIRATORY INFECTIONS
Hemophilus influenzae Streptococcus pneumonia Staphylococcus aureus Enterobacteriaceae Respiratory viruses Fungi, Candida spp Aspergillus's spp

DR.T.V.RAO MD

11

SKIN SEPSIS AND WOUNDS

Staph aureus Streptococcus pyogenes E.Coli Proteus spp Anaerobic bacteria Enterococcus spp Coagulase negative Staphylococcus

DR.T.V.RAO MD

12

GASTRO INTESTINAL INFECTIONS

Salmonella

serotypes Clostridium difficile Norwalk like viruses

DR.T.V.RAO MD

13

DRUG RESISTANCE NOSOCOMIAL INFECTION

The likelihood of exposure leading to infection depends partly on the characteristics of the microorganisms, including resistance to antimicrobial agents, intrinsic virulence, and amount (inoculum) of infective material.

DR.T.V.RAO MD

14

PATHOPHYSIOLOGY
Within

hours of admission, colonies of hospital strains of bacteria develop in the patient's skin, respiratory tract, and genitourinary tract. Risks factors for the invasion of colonizing pathogens can be categorized into 3 areas: iatrogenic, organizational, and patient-related
15

DR.T.V.RAO MD

IATROGENIC RISK

Iatrogenic risk factors include pathogens on the hands of medical personnel, invasive procedures (eg, incubation and extended ventilation, indwelling vascular lines, urine catheterization), and antibiotic use and prophylaxis.

DR.T.V.RAO MD

16

ORGANIZATIONAL
Organizational risk

factors include contaminated airconditioning systems, contaminated water systems, and staffing and physical layout of the facility (eg, nurseto-patient ratio, open beds close together).
DR.T.V.RAO MD

17

PATIENT ASSOCIATED
Patient risk factors

include the severity of illness, underlying immunocompromised state, and length of stay. Prolonged stay in the hospital is a Major contributing factor
DR.T.V.RAO MD

18

ROUTES OF TRANSMISSION OF INFECTION A susceptible host and appropriate inoculum of infecting microorganism with an appropriate route of transmission contributed in majority of cases
DR.T.V.RAO MD

19

AIR BORNE ROUTE

From respiratory tract via talking, coughing, sneezing From the skin by natural shedding of the skin scales during would dressing or bed making. From aerosols from equipment, respiratory apparatus, airconditioning plants.

DR.T.V.RAO MD

20

CONTACT SPREAD
In direct contact spread from person to person By indirect contact spread via contaminated hands or equipment. Clothing of staff, Urinary catheters, contaminated with hands of the operator may introduce organisms, or patients own flora from urethra may contribute to

DR.T.V.RAO MD

21

FOOD BORNE SPREAD

From hospital

kitchen, or in special diets, infant feeds, kitchen, or commercial supplies Mechanical vectors flies, cockroaches or insects, or rodents act as carriers of infection.
DR.T.V.RAO MD

22

BLOOD BORNE SPREAD

The accidental

transmission of infections as HIV, HBV,and HCV by needle stick injuries is documented Syphilis and malaria a concern in high prevalence areas
DR.T.V.RAO MD

23

SELF INFECTIONS AND CROSS INFECTIONS

Lower bowel surgery, Self infection may occur due to flora from nose, Staphylococcus may be introduced into wounds. Cross infection between patients occur due to spread of Staphylococcus or coli forms

DR.T.V.RAO MD

24

OTHER CONTRIBUTING FACTORS

Surgeons punctured

surgical gloves, or moistened gown, imperfectly sterilized surgical instruments, or by airborne theatre dust. Faulty wound dressings may cause infections.
DR.T.V.RAO MD

25

PATIENTS OWN FLORA TOO INFECTIVE

Self

infection from patients own flora from Bowel can be major contributor of infections in bowel surgery.
26

DR.T.V.RAO MD

OTHER SOURCE OF HOSPITAL INFECTIONS

Hospital environment,

includes defective constructions, People their behavior has great impact. Objects, food, water, Air in the hospital too contribute to infections.
DR.T.V.RAO MD

27

CROSS INFECTION

DR.T.V.RAO MD

Many different bacteria, viruses, fungi and parasites may cause Nosocomial infections. Infections may be caused by micro organism acquired from another person in the hospital (cross-infection) or may be caused by the patients own flora (endogenous infection).

28

USED/CONTAMINATED SYRINGES A GREAT THREAT IN DEVELOPING WORLD

Some organisms

may be acquired from an inanimate object or substances recently contaminated from another human source (environmental
DR.T.V.RAO MD

infection).

29

CHANGING TRENDS IN INFECTION ETIOLOGY

With advances in more elaborate surgery and

intensive care, with combined use of broad spectrum antibiotics and immunosuppressive drugs, Gram Negative bacteria increased in importance Pseudomonas aeruginosa gained importance in causing infection in compromised patients. They exhibit natural resistance to antibiotics and antiseptics
DR.T.V.RAO MD

30

EMERGING INFECTIOUS AGENTS

A group of Microbes

that played no role in the past have emerged. 1 Coagulase negative Staphylococci 2 Acinetobacter baumanii

DR.T.V.RAO MD

31

MICROBES FROM ENVIRONMENT

The dissemination from

environment such as cooling towers and hot water system is proving a threat with Legionella pneumophila causing infections of respiratory systems
32

DR.T.V.RAO MD

VIRUS TOO PLAY A IMPORTANT ROLE

Awareness on risk of Blood born viruses including Hepatitis B, C and HIV essential CMV virus in association with organ and cellular transmission
DR.T.V.RAO MD

33

IATROGENIC SPREAD A CONCERN

The

possible risk of iatrogenic spread of Prions causing Creuzfeldt-Jacob disease is a concern

34

DR.T.V.RAO MD

COMMON SITES ASSOCIATED WITH ETIOLOGICAL AGENTS

Urinary tract Surgical wounds Respiratory tract Skin (especially burns) Blood (bacteraemia) Gastrointestinal tract Central nervous system
35

DR.T.V.RAO MD

COLLECTION OF DATA IN CROSS INFECTIONS

Always collect information and document information on 1 Patient details 2 Site and extent of infection 3 Date of admission operative procedure first recognition of infection 4 Specimen and laboratory isolates and typing results 5 Ward and staff details.
36

DR.T.V.RAO MD

PREVENTION AND CONTROL

The basic responsibility of any good hospital remain with establishment of good infection control policies, which can always be achieved with 1 An infection control committee 2 An Infection team

DR.T.V.RAO MD

37

INFECTION CONTROL COMMITTEE

Should meet regularly to formulate and update policies for the whole hospital on all matter which have bearing on infection control and to mange outbreaks of Nosocomial infection

DR.T.V.RAO MD

38

INFECTION CONTROL TEAM

Which will function

under the guidance of Infection control Doctor. A Medically qualified Microbiologist, who will take responsibility of day to day for the policies formulated
DR.T.V.RAO MD

39

THE FUNCTIONS OF THE COMMITTEE

To do surveillance and infection monitoring of hygiene practices. Educate the Medical and Paramedical staff on policies relating to prevention of infection, and safe procedures

DR.T.V.RAO MD

40

INFECTION CONTROL NURSE

Is

the key member of the team

Maintain the close working relations between Microbiology Laboratory, different clinical services and supportive services like laundry, pharmacy and engineering
41

DR.T.V.RAO MD

ALL ARE CAMPAIGNERS OF SAFE PRACTICES

It

is the minimal responsibility of the members to campaign on issues related to safe practices including Hand washing
42

DR.T.V.RAO MD

DECONTAMINATION AND STERILIZATION

Fundamental importance lies with supply of sterile instruments, dressings and fluids. A availability of single use syringes, needles, catheters and drainage bags to be assured and planned for the regular supplies .

DR.T.V.RAO MD

43

ASEPTIC TECHNIQUES

A no touch technique when dealing with sterile equipment coupled with strict personal hygiene. A strict rules laid when dealing the patients in the operation theatre and other procedures such as wound dressing and insertion of IV and urinary catheters.

DR.T.V.RAO MD

44

CLEANING AND DISINFECTION

Basic cleaning, waste disposal, and laundry carry priority. The use of chemical disinfectants for wall floors, and furniture is warranted in special circumstances, such as spillages, of body fluids from patients with blood born viral infections

DR.T.V.RAO MD

45

CARE OF MOP HEADS AND OTHER ITEMS

All the Mop heads and cloths used in crucial areas should be heat disinfected and stored in dry places after use. Bed pans washers and disinfectants and dishwashers should be monitored to ensure reliable performance

DR.T.V.RAO MD

46

SKIN DISINFECTION AND ANTISEPTICS

Hand washing is a most important procedure which should be practiced by health care worker, gram ve bacteria on the hands of the staff is an important factor in the spread of hospital infection
47

DR.T.V.RAO MD

HAND WASHING
Thorough hand washing after any procedure involving nursing care or close contact with the patient is essential. Alchool based hand antiseptics gaining importance where washing with water and soap are not practicable.

DR.T.V.RAO MD

48

WEARING A GLOVE

Gloves may be worn for any dirty contact procedure such as emptying a urinary cans, or bed pans, however it should not be forgotten gloved hand may also become colonized by transient hospital flora.
49

DR.T.V.RAO MD

DISINFECTION POLICIES
All

the hospitals should create disinfection policies which suit circumstances and economic resources. The procedures and products should have a limited range of options, and chemicals to be used only in desired circumstances. The policies should take into consideration surgical instruments, heat disinfection, Laundry, crockery and cleaning of floors and furniture.
DR.T.V.RAO MD

50

IMPORTANCE OF STAFF
Staff

should have well understood responsibilities. Effective implementation of policy requires , motivated staff, with training, Regular updating as new methods become available
DR.T.V.RAO MD

51

PROPHYLACTIC ANTIBIOTICS

Wide spread and haphazard use of antibiotics hasten emergence of antibiotic resistant bacteria. Rational antibiotic prophylaxis plays an important role in infection control Antibiotic policy limits the use of broad spectrum agents, and is important in both prophylaxis and treatment.

DR.T.V.RAO MD

52

PROTECTIVE CLOTHING
Different activities within the hospital require different degrees of protection to staff and patients. In operation theatre the wearing of sterile gowns, gloves, head gear and face mask minimizes the shedding of microorganisms.

DR.T.V.RAO MD

53

BARRIER NURSING

Barrier nursing is highly essential when soiling of clothing is anticipated, and dealing with communicable diseases, eg in EBOLA and MARBURG infections.
54

DR.T.V.RAO MD

OTHER MEASURES
Gloves, face mask, and

goggles are indicated in specific procedures. The use of the above should confirm to international standards and the staff should be trained in their proper use and disposal
DR.T.V.RAO MD

55

ISOLATION IN INFECTIOUS DISEASES

Practiced as

a source isolation and to protect the susceptible or immunocompromised. It needs a highly disciplined approach by all staff to ensure that none of the barriers to transmission are breached.
56

DR.T.V.RAO MD

CUBICLE ISOLATION
In which patient nursed alone in a room separated by door and corridor from other patients confers a substantial measures of protection. Desirable to supply clean, filtered air is supplied to room with facilities for own toilet and washing facilities

DR.T.V.RAO MD

57

CRITICAL SITUATIONS

In some critical situations such as bone marrow transplant units, where air borne contamination with environmental fungal spores is a problem the efficiency of an air filtration may be increased and laminar airflow maintained as barrier around the patient
58

DR.T.V.RAO MD

TREXLER ISOLATOR
Stringent

isolation such as a plastic tent or Trexler isolator, is required only for patients with highly contagious infections.
59

DR.T.V.RAO MD

HOSPITAL BUILDING AND DESIGN

Routine maintenance of the Hospital building is important, ensuring that surfaces wherever possible are smooth, impervious and easy to clean. All constructions around the existsting Hospitals generate fungal spores and bacterial spores with have impact on specialized units serving immunocompromised patients

DR.T.V.RAO MD

60

LEGIONNAIRES DISEASE PREVENTION The risk of Legionnaires disease is reduced by regular flushing all outlets and installing water supplies that circulate below 200c for the0 cold and above 60 c for the hot circuit

DR.T.V.RAO MD

61

EQUIPMENT
All the equipment in contact with patients need decontamination and sterilization Heat is a preferred method. However heat sensitive to the sterilized with chemical and other newer emerging methods

DR.T.V.RAO MD

62

PERSONNEL CARE OF HEALTH CARE WORKERS

All health care workers should screened for possible communicable diseases before employment, and offered immunization against Hepatitis B Viral infection. An education on Universal Health Precautions is highly essential

DR.T.V.RAO MD

63

NEEDLE STICK INJURIES

Who sustain needle

DR.T.V.RAO MD

stick injuries from potentially contaminated sources should have access to advise and post exposure prophylaxis with antiviral agents or immunization.

64

MONITORING OF THE ENVIRONMENT ?

Routine Microbiological monitoring of the environment is of little benefit, But monitoring of the Air conditioning plants, and machinery used for disinfection and sterilization is essential

DR.T.V.RAO MD

65

SCREENING OF STAFF OR PATIENTS

Microbiological screening of staff and patients not undertaken routinely but it may be needed for specific purpose to detect carriers or MRSA and Hepatitis viruses in those performing some types of surgery or where transmission to patients has occurred.

DR.T.V.RAO MD

66

SURVEILLANCE AND ROLE OF MICROBIOLOGY LABORATORIES

The detection and identification of hospital infection incidents or outbreaks rely on the laboratory data that alert the infection control team to unusual cluster of infection, called as alert organism system.
67

DR.T.V.RAO MD

SURVEILLANCE
Identification of

MRSA & ESBL and timely information to clinicians will help the ongoing events in the Hospital warrant to track the events on source of outbreaks and action to control the similar situations in future
68

DR.T.V.RAO MD

PRACTICAL TEACHING TO STAFF

Regular visits to wards are also important to record data on infected patients from whom no specimens have been received and to respond to problems as they occur. Such visits will bring in grater human interaction with paramedical staff and deliver the practical teaching.

DR.T.V.RAO MD

69

EFFICACY OF INFECTION CONTROL

The Following measures will

infections 1 Sterilization 2 Hand washing 3 Closed drainage systems for urinary catheters. 4 Intravenous catheter care 5 Peri operative antibiotic prophylaxis for contaminated wounds, and care of equipment used in respiratory therapy.
DR.T.V.RAO MD

certainly control the

70

MEASURES PROVED TO BE INEFFECTIVE

Chemical disinfection

of floors, walls, and sinks Routine environmental monitoring is losing its concerns.

DR.T.V.RAO MD

71

WHAT IS MOST IMPORTANT

Effective surveillance and action by the infection control team have shown to reduce infection rates. One important role of the team is to monitor compliance and practices known to be effective.

DR.T.V.RAO MD

72

SAVING THE COSTS IN PREVENTION IF INFECTIONS

With raising

DR.T.V.RAO MD

economic costs in running safe hospitals eliminate the many rituals or less effective practices that they may even increase the incidence or cost of cross infection.

73

 Programme created by Dr.T.V.Rao MD for Health care workers in the Developing World
Email doctortvrao@gmail.com

DR.T.V.RAO MD

74