hospital acquired infection 11-11-11

8/3/2019 Hospital Acquired Infection 11-11-11

1/51

HOSPITAL ACQUIRED(NOSOCOMIAL) INFECTION

Salimah DossaMAC,(UK) MSCN,BSCN,(USA) PGD,Specialization in

Psychiatric Nursing & Advance Midwifery, RNM(AKUH)

Murshid Hospital & Health Care Centre


2/51

Welcome to the hospital!Bugs are waiting for you!!!


3/51

DEFINITION:

ANY INFECTION ACQUIRED BY A PATIENT

IN HOSPITAL

OR

Infections that occur during hospitalization but are not

present nor incubating upon hospital admission

"nosus" = disease"komeion" = to take care of


4/51


5/51

Why Do HAI Occurs


6/51


7/51

Who

All hospitals?

All departments?

All specialties?

Other health institutions?

Why Not?

Working in high-risk areas

Lack of hand hygiene promotion

Lack of role model

Lack of institutional priority


8/51

Common Sources of HAI

Reservoirs & Routes of Transmission


9/51

SOURCES

1.Patients own flora - Endogenous (50%)

Auto-Infection

(Greatest source of potential danger)

2.Environment - Exogenous (15%)

(Air-5%; Instruments-10%)

3.Another Patient/Staff - Cross Infection (35%)


10/51

Reservoir & Route of Transmission

Pathogen Transmission Susceptible host

Fungus Contact Visitors

Bacteria Vector Health care workers

Parasite Vehicle Patients

Virus Droplet

Airborne


11/51

Clinical Features of HAI

Pain

Fever

Night Sweat

Inflammation

Breathing Difficulties

Rapid Breathing

Mental Confusion

Low blood Pressure

Reduce Urine Output WBC high count


12/51

Hospital Associated Infections

HAI

Risk Factors


13/51

ICUs Are Dangerous Places!!!

The sickest pts are placed in proximity

Anti Biotics are given empirically in large doses

Devices are everywhere (often pts have 3, 4 or more)

Busiest unit in the hospital

Uses the most sophisticated

equipments

Higher infection rates:

Severity of illness

Frequent use of invasive devices Staff busy caring for very ill pts

Staff move from one pt to other without washing hands

Longer ICU stay prolonging the risk of exposure

Space limitations, ?risk of contaminating equipments


14/51

Sources of Cross Infections in ICUs

Hands of staff and attendants

Assisted ventilation equipments

Suction and drainage bottles

IV lines (central and peripheral)

Urinary catheters

Wounds and wound dressings

Disinfectant containers

Dressing trolleys

Bed rails Phones and computers keyboards


15/51

Healthcare-Associated Infections inICU

UTI (catheter associated)

Pneumonias

Catheter-related

bloodstream infections

Surgical sites infections


16/51

NICU Major Risk Factors for HAI Low birth weight

Exposure to invasive devices Acuity of underlying illness

Surgery

Viral infections

Increase duration of hospitalization

Use of broad spectrum A/B

Overcrowding

Poor staffing ratios

Rates of infections in NICUs have varied from 6 to 40%

New Born requires surgery


17/51


18/51


19/51

Importance of Prevention &Control of HAI


20/51

Preventing HA Infections

Decrease morbidity

Decrease mortality

Decrease hospital stay

Decrease hospital cost (self or third party payers)

Decrease spread ofMDR pathogens to pts, Health Care

Workers, visitors,

Prevent bad reputation of a hospital & legal actions

Prevent Loss of accreditation


21/51

What Can

We Do?

Measures to Reduce the Risk of HAI


22/51

Control of HA Infection

Effective IC program to control transmission of infection

to patients, HCW, visitors

A multidisciplinary committee that oversees the program

Responsibility assigned to qualified people Written policies and procedures for all pt care services &

departments


23/51

Strategies to Reduce

Infection Risk

Assessment of pts upon admission to the unit for infectious risk:Diarrhea

Rashes or skin lesions

Recognized communicable diseases

Known carrier of an epidemic strain of bacterium

Isolation


24/51

Many Personnel Dont Realize When

They Have Germs on Their Hands

Healthcare workers can get 100s to 1000s ofbacteria on their hands by doing simple taskslike:Pulling patients up in bed

Taking a blood pressure or pulse

Touching a patients hand

Rolling patients over in bed

Touching the patients gown or bed sheets

Touching equipment like bedside rails, over bed tables, IV pumps


25/51


26/51

GENERAL PRINCIPLES

Good general ward hygiene:- No overcrowding

- Good ventilation- Regular removal of dust- Wound dressing early in day- Disposable equipment

HAND WASHING

most important -

Before and after patient contactbefore invasive procedures


27/51

Why

Dont Staff Wash their Hands(Compliance estimated at less than 50%)

Why Not?

Skin irritation

Inaccessible hand washing facilities

Wearing gloves

Too busy

Lack of appropriate staff

Being a physician

( Improving Compliance with Hand Hygiene in Hospitals Didier Pittet. Infection Control and Hospital Epidemiology.Vol. 21 No. 6 Page 381)


28/51

Areas Most Frequently Missed

HAHS 1999


29/51

Routine Hand Wash


30/51

Prevention

Protection


31/51


32/51


33/51


34/51


35/51


36/51


37/51


38/51


39/51


40/51

Environmental Factors and Design Issues

Beds: at least 2.5-3 m in ICUs apart to allow movement of

staff and equipment and to reduce risk of cross

contamination

Sharp containers within easy access

Privacy partitions made of material easily cleaned weeklyand any time it becomes soiled

Curtains should be changed weekly and in between

Pts Windows should remain closed to control airborne risks

Plants and flowers should not be allowed in the units

Sinks should be placed near the entrance and at key points

Sinks assigned for hand washing should not be used to wash

instruments

Waterless hand rub dispensers at entrance and each bedside


41/51

Infection Control Measures in the NICU

Proper nursery design

Incubators or heating beds spacing of 6 feet

One sink in a unit

Filters should be at least 90% efficient

Access to isolation rooms

Avoid admissions of pts with contagious disease or place in isolation

room

Special protection during constructions


42/51

Employees in the NICU Represent a possible vehicle for transmission of infectious agents

Should be immune to rubella, measles, polio, Hep B, and influenza Employees who have suffering form any infectious disease should be

excluded from work

Orientation should include:

Basic infection control concepts

Hand hygiene

Management of sharp objects

Wear proper attire

Gowns should be used for isolation and when soiling is possible

Wearing of employee scrubs is of no IC benefit


43/51

Visitations in the NICU

Policies should be flexible and liberal but safe

Parents should be encouraged to visit

A trained HCW should interview visitors outside of the nursery to

assess their health

No persons with symptoms of an acute contagious illness should be

allowed to visit

Should perform appropriate hand hygiene

No contact with pts other than the one they are visiting

Should not handle pt care equipment

Visitor restrictions may be necessary during community outbreaks,

particularly RTI such as influenza


44/51

Environmental Cleaning Cleaning with the hospital approved agent

All surfaces must be wiped with a damp cloth to remove dust anddirt

In the nursery chemicals should be used with extreme caution since

absorption through the skin can cause further more demage

Appropriate high-level disinfection or sterilization of equipments


45/51

We can only prevent what wecan understand !!!

All units should have :

Histograms about frequency of common pathogens

Time-trended surveillance data on different HAI

Data on specific AB susceptibility patterns Education about risks of HAI

Provide meaningful feedback to HCWs


46/51


47/51


48/51

If HAI not Treated or HAI Result in:


49/51

Conclusion

Hospital Pathogen Unhappy

patients

Hospital SurveillanceHappy

Patients

Unhappy

Director / CEO

Happy

Director / CEO


50/51

Any Questions???

Thank you for not asking!!!


51/51

tHanK YoU fOr yoUr cOopeRatiOn anUnTiriNg sUPpoRt FoR LiStEnIng

hospital acquired infection 11-11-11

Documents