hospital acquired infection-management, prevention-control & awareness
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By: Ms. Priyanka Wandhe-FacultyDepartment of Business Administration,Dhanwate National College, Nagpur.
Hospital Acquired Infection-
Management, Prevention-Control
& Awareness
HOSPITAL ACQUIRED INFECTION
DEFINITION :
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 infection acquired in hospital but
appearing after discharge, and also occupational
infection among staff of the facility.
Types of Hospital Acquired Infection
Contact Transmission• Direct Contact Transmission• Indirect Contact Transmission
Droplet Transmission
Common Vehicle Transmission
Vector Borne Transmission
Blood borne spread
Self Infections and Cross infections
Other sources of Infection
Patient Apparatus
Formites
Staff
Endogenous
Other Patients
Air
Greater exposure to hospital atmosphere, long stay.
Inadequate ventilation, faulty design of wards and Ots.
Non availability of isolation rooms for infected case and clear utility room.
Over crowding in hospital wards, floor beds and rush in O.P.D.
The use of indwelling catheters.
Factors Increasing Hospital Acquired Infection
Contd…Intimate contact between staff, patient, relatives. No fixed time schedule for visitors.
In adequate and substandard aseptic procedures.
Failure of healthcare workers to wash their hands.
Overuse of antibiotics.
Poor sterilization, laundry, and kitchen services.
Factors influencing Development of Hospital
Acquired Infection1. THE AGENT-THE MICROBIAL AGENT:
Organisms Percentage
E.coli 20%
Staphylococcus aureus 11%
Other staphylococci 11%
Pseudomonas 9%
Klebsiella 9%
Proteus 8%
Others/Mixed 32%
Organisms responsible for human infection
2. The Host: Patient Susceptibility:
Important patient factors influencing acquisition of infection include:-
Extreme of age
Immunosuppressant
Underlying disease like:-
Tuberculosis
Diabetes
Severe anemia
Malignancy
Renal failure, AIDS, diagnostic and therapeutic intervention.
3. The Environment
Other patient, hospital staff or visitors, food, water, dust and other contaminated inanimate articles.
Drug resistance microorganisms and change from non-pathogenic strain to pathogenic are found commonly.
4. Bacterial resistance
• Emergence of multi drug resistant strains, many strains of Pneumococci, Staphylococci, Enterococci and Tuberculosis are currently resistant to most of all antimicrobials which where once effective.
NOSOCOMIAL INFECTION SITES
Urinary Infection.
Surgical Site Infection.
Respiratory Tract Infection.
Nosocomial Pneumonia.
Nosocomial Bacteraemia & septicemia.
Other Nosocomial Infection:• Skin & soft tissue infection• Gastroenteritis• Infection of eye• Other infection of reproductive organs following child birth.
High Risk Areas in HospitalNurseries
Intensive care unit
Dialysis unit
Organ transplant unit
Burn unit
Isolation ward
Cancer ward
Operation theatres
Delivery rooms
Post-operative ward
Causes of Hospital Acquired Infection
Urinary bladder catheterization
Surgery and wound
Intravenous (IV) procedures
Biomedical waste
Lack of Awareness
SIGNS & SYMPTOMS OF HOSPITAL ACQUIRED INFECTION
Increased TLC count (High white blood cell count).
Fever.
Rapid Breathing.
Mental Confusion.
Hypotension.
Reduced urine output.
Contd…Swelling.
Redness.
Tenderness at the site of Infection.
Coughing.
Dyspnoea.
Haematurea and Skin infections etc.
Diagnosis of Hospital Acquired Infection is based on the following:
Symptoms and signs of patient.
Examination of wounds and catheter entry sites.
Review of procedures that might have led to infection.
Laboratory test results(WBC count High).
MANAGEMENT OF HOSPITAL ACQUIRED INFECTION
The basic responsibility of any good hospital remains with establishment of good infection control policies and proper management which can always be achieved with:- Hospital Acquired Infection Control Committee.
Composition of Hospital Acquired Infection Control Committee consists of the following:-
Chairperson
Physician
Microbiologist
Nursing Staff
Central Sterilization Service
Laundry Service
Food Service
House Keeping Service
PREVENTION & CONTROL OF HOSPITAL ACQUIRED
INFECTIONExtensive infection control programmes.
Aseptic (sterile) techniques.
Frequent Hand washing.
Early signs of infection are to be identified.
Antibiotics should be used only when necessary.
Frequent changing of dressings.
Isolation of Infected patients.
Awareness Programmes for Staff.
Contd…
Standard Guidelines by WHO:-
• Frequent Hand Wash after contact with infective material and after removing gloves.
• Wear gloves.• All sharps should be handled with extreme care.• Disposal and Segregation of biomedical waste.
Research Approach
The approach towards studying the awareness level about HAI is to gain maximum knowledge about various preventive facilities in an organization.
During the study, various documents, Personnel Manuals and SOP available in the organization were studied.
To study the compliance of these facilities and to study the response of the nursing staff, RMO, Micro biology Lab technicians on the preventive facilities, personal interviews will be carried out with the staff members, and accordingly observations can be done.
RESEARCH METHODOLOGY
To study the current rate and know the prevalence of HAI in hospital.
To identify HAI in the region, analysis and interpretation of data, observation and evaluation of patient care practices, monitoring equipments and the environment in order to generate infection surveillance data.
To apply control measure and provide the highest possible standards of infection control within the limitations of available resources, prospective study to monitor the problem, evaluate the control measure and detect future recurrences and provide education.
To provide suggestions for prevention of HAI.
Objectives of the study
Hypothesis of the study
Application of study of Hospital Acquired Infection improves the hygienic conditions of the organization.
The management is doing very admirable job in providing preventive facilities to all the patient, visitors and the staff of the organization.
Tools For Data Collection
PRIMARY DATA COLLECTION:
• Questionnaire• Personal interview• Observation
SECONDARY DATA COLLECTION:
• Hospital information system.• Collection of data of discharged patients on the basis of non infected and infected patients from infection control nurse.• Internet.• Books and Magazines.• Journals.
Research Design for the study
Descriptive Research Design
Exploratory Research Design
Sample Size taken for the study
Male & Female Nurses:- 60
Lab. Technicians:- 10
Residential Medical Officers:-10
Limitations of the study
The data will be collected through questionnaire. the response from the respondent may not be accurate, they may be bias and could be influenced by external factors.
The sample size taken for the study and the results drawn may not be accurate.
Limited time span of the project.
DATA ANALYSIS AND INTERPRETATION
SITE:- ORGANISM
HAP VAP
UTI
WOUNDINFECTION
TOTAL
STAPHYLOCOCCI ----- 1 2 ----- 3
PSEUDOMONAS ----- 2 1 ----- 3
KLEBSIELLA PROTEUS SPECIES
5 2 ----- ----- 7
E.COLI 4 ----- ----- ----- 4
STREPTOCOCCUS
----- ----- ----- ----- -----
ACINETOBACTER
----- ----- ----- ----- -----
SALMONELLA ----- ----- ----- ----- -----
SHIGELLA ----- ----- ----- ----- -----
CANDIDA 1 ----- ----- ----- 1
TOTAL 10 5 3 ----- 18
STAPH
YLOCOCCI
PSEUDOMONAS
KLEBSIE
LLA PR
OTEUS S
PECIES
E.COLI
STREP
TOCOCCUS
ACINETOBACTE
R
SALM
ONELLA
SHIGELL
A
CANDIDA
01234567
Rate of Comparision of Microorganisms
ORGANISM
HAP VAP UTI WOUND INFECTION
0123456789
10
Rate of Comparision of Nosocomial site
SITE
Interpretation: It was observed that the rate of microorganism i.e Klebsiella proteus spp. was high as compared to other microorganisms.
Interpretation: It was observed that the rate of Nosocomial site i.e Hospital Acquired Pneumonia was high as compared to other SITE.
High Risks Areas found in Hospital for HAI
WARD No.
TOTALPt.516
VAP HAP UTI WOUND SWAB
WARD WISE
RATE
D/W 67 ---- 2 1 ---- 3 4.48%
3rd
G/W70 ---- 1 ---- ---- 1 1.43%
2nd
G/W128 ---- ---- 1 ---- 1 0.78%
5th
G/W90 ---- 1 ---- ---- 1 1.11%
ICU 82 5 1 1 ---- 7 8.54%
PICU/NICU
42 ---- ---- ---- ---- ---- ----
CTR 18 ---- 3 ---- ---- 3 16.67%
POSTCATH
19 ---- 2 ---- ---- 2 10.53%
TOTAL 516 5 10 3 ---- 18 3.49%
Interpretation: It was observed that the rate of Hospital Acquired Infection was higher in the month of Jan (5.15%) and least in the month of Feb (1.18%).
HOSPITAL ACQUIRED INFECTION TOTAL No. OF ADMISSIONS=516 TOTAL No. OF HOSPITAL ACQUIRED INFECTION=18 18/516*100=3.49%
Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-160.00%
1.00%
2.00%
3.00%
4.00%
5.00%
6.00%5.15%
1.81%
3.01%
3.52%3.21%
3.49%
OBSERVATIONS
0102030405060
Nursing Staff aware about HAI...
NOT AWAREMOD.AWAREFULL AWARE
Full Aware95%
Mod. Aware5%
Nursing StaffInterpretation: It was found that 95% nursing staff is full aware and 5% nursing staff is mod. aware about Hospital Acquired Infection.
Hospita
l Acqu
ired In
fectio
n
HAI Tra
ining S
ession
Source
s of In
fectio
n
Cause
s of In
fectio
n
Diagno
sis
Antib
iotic P
rotoco
l
IV Pro
cedure
s
Cann
ulatio
n and
Steri
lizatio
n
Cathe
rizati
on an
d Cath
eter C
are
Post- O
perat
ive Care
Hand W
ashing
techn
ique
Disinfec
tants
Linen
Washing
Biomed
ical W
aste
Preve
ntive
Health
Check-u
p
Vacci
nation
again
st Hep
atitis-
B
Preve
ntion
again
st need
le stic
k inju
ry
Preve
ntion
again
st HIV/AIDS
Univers
al Prec
aution
Infect
ion Con
trol C
ommitte
e0123456789
10
RMO's aware about HAI...
NOT AWAREMOD.AWAREFULL AWARE
Full Aware97%
Mod. Aware3%
RMOInterpretation: It was found that 97% RMO is full aware and 3% RMO is mod. aware about Hospital Acquired Infection.
Hospita
l Acqu
ired In
fectio
n
HAI Tra
ining S
ession
Source
s of In
fectio
n
Cause
s of In
fectio
n
Diagno
sis
Antib
iotic P
rotoco
l
IV Pro
cedure
s
Cann
ulatio
n and
Steri
lizatio
n
Cathe
rizati
on an
d Cath
eter C
are
Post- O
perati
ve Care
Hand W
ashing
techn
ique
Disinfec
tants
Linen
Washing
Biomed
ical W
aste
Preve
ntive
Health
Check-u
p
Vacci
natio
n aga
inst H
epatiti
s-B
Preve
ntion
again
st nee
dle st
ick in
jury
Preve
ntion
again
st HIV/AIDS
Univers
al Prec
aution
Infect
ion Con
trol C
ommitte
e0123456789
10
Micro.Lab.Technicians aware about HAI...
NOT AWAREMOD.AWAREFULL AWARE
Full Aware90%
Mod. Aware6%
Not Aware4%
Micro Lab. TechInterpretation: It was found that 97% Micro.Lab.Tech.is full aware,6%Micro.Lab.Tech is mod. aware and 4% Micro. Lab. Tech is not aware about hospital Acquired Infection .
CASE STUDY Name: Mr. N. P. Sinha (16175)
Date of Admission: 25/08/10
Source of History: Colleagues
Chief Complaints: Patient admitted with alleged H/O trapping of clothes in machine and sustaining trauma to chest and abdomen at around 12P.M. while at work at Ordinance factory, Ambazari.
Injuries: LW Right eyebrow abrasion of abdomen over chest and abdomen contusion Left knee medical aspect, LW Right forehead.
Diagnosis: Polytrauma/Industrial trauma
FINDINGS OF THE STUDY
Lack of proper hand hygiene.Lack of awareness about the sterile ways.Lack of knowledge about disinfectants, handling the
infected cases.Don’t have Isolation wards.Improper segregation & Disposal of Biomedical
Waste. Needles: Not using needle destroyers.Blood spills: Blood spills not handled properly.
CONCLUSION The data collected comprising in the table was found that most of the staff that is
nursing staff, RMO, Miro. Lab-Technicians have awareness about HAI.
The remaining of the staff partially is not aware because of the lack of training regarding HAI, lack of hand hygiene practices etc.
The management has well established the norms of HAI by providing the preventive facilities to the staff.
The live case study of Mr. N.P. Sinha which the researcher have undergone during my project work, it was found that due to the irresponsible behavior of organization towards the live case, hence it was found that the severity regarding infection of the patient was increasing day by day and because of this, finally the patient crushed down.
Thus, the effective and efficient awareness, training and teaching among the staff should be there so that it will decrease the death rate, decrease the health care cost, decrease the antibiotic resistance and thereby increasing the patient turnover and hence helps to improve the image of hospital and the hygienic conditions of the organization.
SUGGESTIONS Proper coordination. On job training sessions should be interactive. Increase awareness, monitoring, surveillance and
participation regarding Hospital Acquired Infection. Hand hygiene practices (hand wash and hand disinfectant). No brooms only wet mops to be used. Isolation of the patient with HIV, HBs Ag should be
followed strictly. Needles care. Antibiotic protocols should be followed properly. An early sign of symptoms should be detected for further
diagnosis.
Thank You
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