hospital acquired (nosocomial) infection by mahboob ali khan cphq usa
DESCRIPTION
Nosocomial infections are commonly transmitted when hospital officials become complacent and personnel do not practice correct hygiene regularly. Also, increased use of outpatient treatment in recent decades means that a greater percentage of people who are hospitalized today are likely to be seriously ill with more weakened immune systems than in the past. Moreover, some medical procedures bypass the body's natural protective barriers. Since medical staff move from patient to patient, the staff themselves serve as a means for spreading pathogens. Essentially, the staff act as vectors.TRANSCRIPT
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HOSPITAL ACQUIRED (NOSOCOMIAL) INFECTION
Mahboob Ali Khan MHA CPHQ USA Harvard
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DEFINITION:
ANY INFECTION ACQUIRED BY A PATIENT IN HOSPITAL.
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SOME STATISTICS:
• Affects approx. 10% of all in-patients • (KFHUrate the last 5 years 1.14%)• delays discharge • HAI costs 2times >no infection• direct cause deaths
Socio-economic burden of HAI
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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%)
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Classification of surgical procedures
Cleanno entry into GI/GU/Resp tractlow riskinfection usually exogenous
Clean contaminatedno significant spillagee.g. cholecystectomy
infection rates 5-10 %
Contaminated Significant spillage of bacteria expected Infection rate 18-20%
DirtyPerforated viscus drainage of abscess Infection rate often >30%
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IMPORTANT CROSS-INFECTION ORGANISMS
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METHICILLIN RESISTANT STAPH AUREUS (MRSA)
Resistant to Flucoxacillin and usually others
May cause - Wound infection Bacteraemia Skin/soft tissue infection U.T.I. Pneumonia etc.
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Colonisation common:
Nose Axilla Perineum Wounds/Lesions
Spread By:
Hands Fomites Aerosols Becoming more common in the Community
Control:
Eradication of carriage Barrier nursing Screening of other patients Staff
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TUBERCULOSIS Open pulmonary TB (Sputum smear positive for AFB)
VIRAL INFECTIONS
Chicken Pox (Hepatitis B HIV)
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RESISTANT GRAM NEGATIVE ORGANISMS
Resistance to multiple antibiotics
Organisms:E .coli Proteus Enterobacter Acinetobacter Pseudomonas aeruginosa
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Cause: Bacteraemia U.T.I. Pneumonia Wound infection
Control: Antibiotic Policy Control of Infection Guidelines Prevention of Cross Infection especially on high risk areas
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SURVEILLANCE
Important means of monitoring HAI Early detection of trends outbreaks 1. Laboratory Based Microbiology Laboratory lists +ve organisms ICN reviews ‘Alert organisms’ reported 2. Ward Based Ward staff monitor patientsICN reviews ICN visits wards
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H.A.I. IS INCREASING: compromised patients ward and inter-hospital transfers antibiotic resistance (MRSA, resistant Gram negatives) increasing workload
staff pressures lack of facilities ? lack of concern
HAI is inevitable but some is preventable (irreducible minimum)
realistically reducible by 10-30%
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Many Personnel Don’t Realize When
They Have Germs on Their Hands• Healthcare workers can get 100s to 1000s of
bacteria on their hands by doing simple tasks like: – pulling patients up in bed
– taking a blood pressure or pulse
– touching a patient’s hand
– rolling patients over in bed
– touching the patient’s gown or bed sheets
– touching equipment like bedside rails, overbed tables, IV pumps
Casewell MW et al. Br Med J 1977;2:1315Ojajarvi J J Hyg 1980;85:193
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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 contact
before invasive procedures
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Why
Don’t Staff Wash their Hands
(Compliance estimated at less than 50%)
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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)
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Why Not?• Working in high-risk areas
• Lack of hand hygiene promotion
• Lack of role model
• Lack of institutional priority
• Lack of sanction of non-compliers
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Successful Promotion • Education• Routine observation & feedback• Engineering controls
– Location of hand basins– Possible, easy & convenient– Alcohol-based hand rubs available
• Patient education(Improving Compliance with Hand Hygiene in Hospitals. Didier Pittet. Infection Control and Hospital Epidemiology. Vol. 21 No. 6 Page 381)
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Successful Promotion • Reminders in the workplace
• Promote and facilitate skin care
• Avoid understaffing and excessive workload; Nursing shortages have caused
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Hand Hygiene
Easy, timely access to both hand hygiene and skin protection is necessary for satisfactory hand hygiene.
A study by Pittet showed a 20% increase in compliance by using feedback and encouraging the use of alcohol hand rubs
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Hand Hygiene Techniques1. Alcohol hand rub
2. Routine hand wash 10-15 seconds
3. Aseptic procedures 1 minute
4. Surgical wash 3-5 minutes
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Repeat procedures until hands are clean
Routine Hand Wash
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Alcohol Hand Rubs
• Require less time
• Can be strategically placed
• Readily accessible
• Multiple sites
• All patient care areas
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Alcohol Hand Rubs• Acts faster
• Excellent bactericidal activity
• Less irritating (??)
• Sustained improvement
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Alcohol Hand RubsChoose agent carefully:
– Adequate antimicrobial efficacy
– Compatibility with other hand hygiene products
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Visible soiling
Hands that are visibly soiled or potentially grossly contaminated with dirt or organic material MUST by washed with liquid soap and water
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Areas Most Frequently Missed
HAHS © 1999
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Hand Care• Nails
• Rings
• Hand creams
• Cuts & abrasions
• “Chapping”
• Skin Problems
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Hand hygiene is the simplest, most effective measure for preventing
hospital-acquired infections.
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PREVENTING CROSS INFECTION
If known or suspected on admission to hospital, or detected following admission:
- Isolation (barrier precautions) - Inform Infection Control team - Treatment - if appropriate - Regular surveillance
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Any Questions???
• Thank you for not asking!!!
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tHanK YoU fOr yoUr cOopeRatiOn and UnTiriNg sUPpoRt