HOSPITAL ASSOCIATED INFECTIONS

ROLE OF RESIDENT DOCTORSDr.T.V.Rao MD

Dr.T.V.Rao MD

PREVENTING INFECTION

IN THE HOSPITAL

Vision:•Vision: to provide the safest healthcare system in the world through creating a zero tolerance approach to avoidable infections, and delivering safe, effective and person centred care through continued improvement in the prevention and control of Healthcare Associated Infections.

Learning Objectives

1. Recognize patient safety as an important nursing responsibility in global health care systems.

2. Apply required knowledge in preventing and/or minimizing infection.

3. Perform appropriate behaviors required to prevent health care associated infections.

4. Demonstrate required competence to provide patients with safe care.

Cannot autoclave patients

Introduction to Patient Safety: Background

• Adverse medical events are widespread and preventable (Emanuel et al., 2008) .

• Much unnecessary harm is caused by health-care errors and system failures.

• Ex. 1: Hospital acquired infections from poor hand-washing.

• Ex. 2: Complications from administering the wrong medication.

Global Infection ProblemsAccording to WHO (2005),

• On average, 8.7% of hospital patients suffer health care-associated infections (HAI).

• In developed countries: 5-10% • In developing countries:

• Risk of HAI: 2-20 times higher• HAI may affect more than 25% of patients

• At any one time, over 1.4 million people worldwide suffer from infections acquired while in hospital.

Health Care-Associated Infections (HAI)

According to WHO:• HAI is also called “nosocomial”.• HAI is defined as:

• 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.

Dr.T.V.Rao MD' TMC Kollam Kerala 9

What is Hospital Acquired Infections

•Any infection that is not present or incubating at the time the patient is admitted to the hospital

What is Infection Control?

• Identifying and reducing the risk of infections developing or spreading

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Lets now put the “Spotlight” on

Infection control in Our Hospitals

Impression of my Hand Showing the Growth of Bacteria

Dr.T.V.Rao MD' TMC Kollam Kerala 13

Why Everyone Concerned with Hospital Infections

•The Centers for Disease Control (CDC) estimates that 2 million U.S. patients a year acquire hospital-related infections.

Impacts of Health Care-Associated Infections (HAI)

HAI can: • Increase patients’ suffering.•Lead to permanent disability.•Lead to death.•Prolong hospital stay. • Increase need for a higher level of care.• Increase the costs to patients and hospitals.

Impact of Nosocomial Infections

They lead to functional disability and emotional stress to the patient.

They lead to disabling conditions that reduce the quality of life.

They are one of the leading causes of death. The increased economic costs are high: Increased length of hospital stay (SSI - 8.2 days), extra investigations, extra use of drugs and extra health care by doctors and nurses.

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Frequency of Nosocomial Infection

Nosocomial infections occur worldwide. The incidence is about 5-8% of hospitalized patients, 1/3 of which is preventable.

The highest frequencies are in East Mediterranean and South-East Asia.

A high frequency of N.I. is evidence of poor quality health service delivered.

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Nosocomial infections can spread to Community

Organisms causing N.I. can be transmitted to the community through discharged patients, staff and visitors. If organisms are multi-resistant they may cause significant disease in the community.

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HAI - common bacteria• Staphylococci - wound, respiratory and gastro-intestinal infections

• Escherichia coli - wound and urinary tract infections

• Salmonella - food poisoning• Streptococci - wound, throat and urinary tract infections

• Proteus - wound and urinary tract infections (Peto, 1998)

• C.difficle an emerging pathogen

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HAI - common viruses

•Hepatitis A - infectious hepatitis

•Hepatitis B - serum hepatitis•Human immunodeficiency virus [HIV] - acquired immunodeficiency syndrome [AIDS] (Peto, 1998)

Required Skills• Apply universal precautions*• Use personal protection methods• Know what to do if exposed• Encourage others to use universal precautions• Report breaks in technique that increase patient risks

• Observe patients for signs and symptoms of infection

Main Sources of Infection• Person to person via hands of health-care providers,

patients, and visitors• Personal clothing and equipment (e.g. Stethoscopes,

flashlights etc.)• Environmental contamination• Airborne transmission• Hospital staff who are carriers • Rare common-source outbreaks

Campaigns to Decrease Infection Rates

•WHO “Clean hands are safer hands” campaign

•Centers for Disease Control and Prevention (CDC) “prevent antimicrobial resistance” campaign in health-care settings

• Institute for Healthcare Improvement (IHI) “5 million lives” campaign• Developing country focus

Antibiotic Resistant Microorganismsnormal flora too can cause Infections

Problem exists because of overuse and inappropriate use

Resistant to multiple antibioticsReduced options for treatmentRequire isolation precautionsExamples: MRSA, VRE, MDR TB Solutions: more appropriate antibiotic use,

better infection control and prevention04/15/2023 Dr.T.V.Rao MD @Health Care 23

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Leading causes of death 53.9 million from all causes, worldwide

Incidence of Healthcare associated infections

• Lack of reliable data affects estimates on the burden- millions worldwide every year

• No health-care facility, no country, no health-care system in the world is free of this problem

• Developed world: 5–10% patients• Developing countries: risk is at least 2 times higher

and can exceed 25%• ICU - 30% patients; attributable mortality as high as

44%25

Main Routes for infections• Urinary tract infections (UTI)

• Catheter-associated UTIs are the most frequent, accounting for about 35% of all HAI.

• Surgical infections: about 20% of all HAI• Bloodstream infections associated with the

use of an intravascular device: about 15% of all HAI

• Pneumonia associated with ventilators: about15% of HAI

Burke J Infection control-a problem for patient safety New Eng Journal of Medicine (February 13, 2003)

Types of Infections

Infection control in developing countries

None/inadequate Infection Control infrastructure Lack of strategic direction at national/local level Lack of resources/financial governance Well-organized, effective infection control programmes are confined to academic institutions, well-funded government and private hospitals Smaller hospitals in urban areas and hospitals in rural centres have less resources

None or inadequate infection control programme Lack of Microbiology Laboratory supports Availability of antimicrobial agents, hand hygiene products and hand washing facilities, Personal Protective Equipment and sterile goods

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NO COST MEASURESGood infection control

practices • Aseptic technique for all sterile procedures • Remove indwelling devices when no longer needed • Isolation of patient with communicable diseases/multi-resistant

organism • Avoid unnecessary Per Vaginal (PV) examination in women in

labour• Placing mechanically ventilated patients in a semi-recumbent

position • Minimize number of people in operating theatre

Damani NN. Journal of Hospital infection 2007; 65(S1): 151-154.

We Doctors and Nurses Have a Great role

•Staff nurses play an important role in risk reduction by paying careful attention to hand hygiene, by ensuring careful administration of prescribed antibiotics, and by following procedures to reduce the risks associated with patient care devices.

Standard precautions•Treating all patients in the health care facility with the same basic level of “standard” precautions involves work practices that are essential to providea high level of protection to patients, health care workers and visitors.

Nosocomial Infections CostThe cost varies according to the type and

severity of these infections. An estimated 1 to 4 extra days for a urinary tract infection, 7 – 8 days for a surgical site infection, 7 – 21 days for a blood stream infection, and 7 – 30 days for pneumonia.

The CDC has recently reported that US$5 billion are added to US health costs every year as a result of NI.

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Include the following:•Hand washing and antisepsis (hand hygiene); use of personal protective equipment when handling blood, body substances, excretions and secretions; appropriate handling of patient care equipment and soiled linen; prevention of needle stick/sharp injuries; environmental cleaning and spills-management; and appropriate handling of waste.

. METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS

• refers to S. aureus organisms that are resistant to methicillin

• 1940- PENICILLIN was discovered

• Soon after penicillin was introduced, S. aureus became all but universally penicillin resistant

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Neonatal sepsis among NICU(University Hospital in Egypt)

• Increase rates of early onset neonatal sepsis among infants in ICU

•Mortality rates : 55%•All infants placed on IV

fluids and antibiotics

Yassin S. et al 5th IFIC Congress Malta, 2003

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Effect of hand washing on child healthRandomised controlled trial in Karachi, Pakistan.

Hand washing with soap and water

Children under age of 5 years

• 50% lower incidence of pneumoniaChildren under age of 15 years

• 53% lower incidence of diarrhoea • 34% lower incidence of impetigo

Luby SP et al. Lancet 2005; 366: 225-33.

Importance of Education

•Educate patients and families/visitors about clean hands and infection transmission.

•Ensure patients on precautions have same standard of care as others:

• frequency of entering the room• monitoring vital signs

Breaking the Chain

How to prevent the spread of Infection

How the Infections Spread

• Pathogens can be transmitted to a host from a reservoir four main ways;

1.By direct contact; exchange of body fluid especially during sexual intercourse

2.By an object; people handle contaminate objects then touch face, nose, eyes, etc…

3.Through the air; person coughs or sneezes spreading droplets which are then inhaled

4.By a vector; insects such as mosquitos, ticks spread pathogens between hosts or reservoirs

CONTROL•Control is best achieved by

1. intensifying cleaning, 2. using Contact Precautions for infected patients 3. stressing glove use 4. hand hygiene for all care workers.

CDC RECOMMENDATION1. Intensified environmental

cleaning using 1:10 bleach : water solution

2. Equipment cleaned whenever visibly soiled

3. Items close to the patient should be cleaned daily

4. IV poles should be cleaned when the patient is discharged.

Five moments for hand hygiene

•Before patient contact•Before an aseptic task•After body fluid exposure even if wearing gloves!

•After patient contact•After contact with patient surroundings

How should you wash your hands?

4 Rinse your hands well under clean, running water.

5Dry your hands using a clean towel or air dry them.

Hand washing reduces spread of MicrobesWe can take to reduce the spread of diarrheal and respiratory illness so you can stay healthy. Regular Handwashing, particularly before and after certain activities, is one of the best ways to remove germs, avoid getting sick, and prevent the spread of germs to others.

Isolation Precautions

Need For Protection

Protecting Whom?

• Protecting:

• Ourselves

• Patient

• Other patients

• Other staff

• Our families

Elements of Standard Precautions

1. hand hygiene2. use of gloves and other barriers (eg, mask, eye protection, face

shield, gown), 3. handling of patient care

equipment and linen4. environmental control5. prevention of injury from sharps

devices6. patient placement.

Hand Hygiene

• hands should be washed with soap and water

• antimicrobial agents (eg, chlorhexidine gluconate, iodophors, chloroxylenol, triclosan) may be used.

Hand Hygiene

• Effective hand washing requires at least 20 seconds of vigorous scrubbing with special attention to the area around nail beds and between fingers, where there is high bacterial burden.

Universal Precautions

• CDC (Centers for Disease Control) in 1987:

• All patients be regarded as potentially infective

(HIV & Hepatitis…)

• that all patients are colonized or infected with microorganisms, whether or not there are signs or symptoms

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Important Conclusions•Nosocomial transmission of pathogenic bacteria creates a major health burden

•Multifaceted interventions are needed for high level control: proper hand hygiene is the cornerstone of prevention efforts

•Isolation of patients may place them at risk for errors of omission

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I washed my Hands Are You ?

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Challenging Issues• Issues that will continue to

impact infection control programs into the new millennium are a challenging combination of clinical factors and increasing cost to treat infections, and financial impact of implementing new government regulations .

Can We Gift Flowers to Patients ?

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Conclusions• Identify unsafe, unnecessary and ineffective infection

control practices • Divert resources to apply basic evidence based practice

in Infection control • Implement simple & effective solutions according to

local need and resources which are achievable and affordable

Simple measures do save lives !

•Program Created by Dr.T.V.Rao MD for Medical Professional to improve the awareness on

Hospital Associated Infections•Email

•doctortvrao@gmail.com