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