prevention of healthcare associated infections sunil esampalli mrcpch, uk
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Healthcare associated Infections
Nosocomial infections Hospital acquired infections
8.7% ( 14 countries, 55 hospitals- 1987)1
Health-care associated infection in Africa: a systemic review by WHO- 20112
- Prevalence 14.8% (2.5-14.8%)- Average European prevalence -7.1%- In Uganda- ?
Ugandan data
Lacor hospital, Gulu, Uganda – In 2011: prevalence of 28% (47% in surgical and 21% in paediatrics)
Mulago hospital – MRSA from surgical wounds, 28.7% of all samples grew staphylococcal aureus and 31.5% of them were MRSA5.
In Kisiizi (unpublished data)- 60% of surgical wounds grew staph aureus. No access to MRSA testing (oxacillin agar screen).
Why should we be worried ?
Increases length of stay Increases morbidity Increases mortality 1.7 million HAI, 90000 deaths – in US 20023
Financial burden Increased mortality in children staying >5 days
“first do no harm” or, Latin phrase, “primum non nocere- 1860
Common HAI’s
Surgical wound sites Surgical drains Central venous catheters IV Cannula sites Urinary catheters
Common organisms
Staphylococcus epidermidis Staphylococcus aureus – often MRSA Enterobacter species Pseudomonas
Often these are resistant to commonly used antibiotics
Do we need to clean our medical equipment? Stethoscopes Pulse oximeter probes Cannula ports when accessing Dangling drip ends
???????
Medical equipment cleanliness
10 different commonly used equipment in paediatric ward Swabs were taken and cultured
Equipment Organism 1 Organism 2
Stethoscope 1 Staph epidermidis
Stethoscope 2 Staph epidermidis
Stethoscope 3 Neiserria catarrhalis
MUAC tape Staph epidermidis coliform
Pulseox probe 1 Pseudomonas sps Bacteroides sps
Pulseox probe 2 Staph epidermidis
Pulseox probe 3 Staph epidermidis
Knee hammer Staph aureus
BP cuff Staph epidermidis
Thermometer Staph aureus
Is alcohol based rub effective?
Equipment Organism 1 Organism 2 Alcohol rub
Stethoscope 1 Staph epidermidis No growth
Stethoscope 2 Staph epidermidis No growth
Stethoscope 3 Neiserria catarrhalis No growth
MUAC tape Staph epidermidis coliform No growth
Pulseox probe 1 Pseudomonas sps Bacteroides sps No growth
Pulseox probe 2 Staph epidermidis No growth
Pulseox probe 3 Staph epidermidis No growth
Knee hammer Staph aureus No growth
BP cuff Staph epidermidis No growth
Thermometer Staph aureus No growth
100 % effective
KISIIZI ALCOHOL HAND RUB FORMULAR FOR 20LITRES (WHO Formula I)
Method of Preparation
Ingredients Quantities
1. Alcohol 95.5 % (absolute) 80% 16000mL
1. Glycerol 98%w/w 0.725% 145mL
1. Hydrogen Peroxide 6%v/v (0.125%) 417mL
1. Distilled Water (fresh) to 20000mL
•Ensure cleaning of the 20 Liter ‘jerrycan’- Final container, and all the measuring cylinders and beakers has been done properly before production begins•Measure 145mL of Glycerol and pour into the final container •Measure 417 ml of 6% Hydrogen peroxide using the same cylinder you used to measure the glycerol so that it help rinse out all the glycerol since it is slightly viscous and pour into the final container.•Measure 16000mL of absolute Alcohol and power into the Final container•Top up to 20000mL with freshly distilled water•Label and allow to sit for 72 hours before use.
ABH cost- WHO survey4 2011
Clean Care is Safer Care- 2005 Thirty-nine sites from 29 countries (79% LIC and MIC)
included in the final data analysis Commercially produced ABH – 2.5 to 8.5USD / 100mls
dispenser Locally produced ABH- 1.6 to 2.2 USD / 100mls including
dispenser and salaries
Professional dress (Am J Med 2005)
Study done in 2005 in US. 76.3% favoured professional attire- white coat Scrubs 10.2% Business dress 8.8% Casual dress 4.7%
African study
The potential for nosocomial infection transmission by white coats used by physicians in Nigeria: implications for improved patient-safety initiatives.
Uneke CJ1, Ijeoma PA.
Swabs taken from cuffs and pockets 91.3% of coats had bacterial contamination Staphylococcus aureus, Gram negative bacteria and
dipheroids
Practice in the UK
White coats Ties Long sleeves Watches bracelets
Bare below elbow policy since 2008 Cleaning equipment after every patient contact Strict hand hygiene- hand washing, alcohol rub
Banned
Practice in the US
Society of healthcare epidemiology of America (SHEA) - Recommendations
A bare below elbow policy Hanging white coat prior to contact patient contact Cleaning stethoscopes and other medical equipment before
seeing next patient. Daily laundering of clothes that touch patients
Recommendations
Use alcohol rub Wash with soap + water -contact with body fluids Bare-below-the-elbow in all clinical settings No wrist watches/ jewellery/ bracelets- except for wedding
rings White coat – wash everyday or don’t use it A nation wide HAI data collection is needed
References1. Tikhomirov E. WHO programme for the control of hospital
infections. Chemioterapia. June 1987. 6(3):148-51
2. Health-care associated infection in Africa: a systemic review by WHO- 2011
3. Klevens RM, Edwards JR, Richards CL, et al. Estimating healthcare-associated infections in US hospitals, 2002. Public Health Rep. Mar 2007. 122(2):160-6.
4. Local production of WHO-recommended alcohol-based handrubs: feasibility, advantages, barriers and costs -Joanna Bauer-Savage , Didier Pittet , EunMi Kim & Benedetta Allegranzi
5. Prevalence of Methicillin resistant Staphylococcus aureus (MRSA) among isolates from surgical site infections in Mulago hospital- Kampala, Uganda. J Ojulong, T Mwambu, M Jolobo, E Agwu, F Bwanga, C Najjuka, D Kaddu-Mulindwa
6.
Summary HAI- cause increased morbidity/ mortality/ financial burden to
patients and hospitals Patient safety is our priority Please don’t hesitate to tell your colleague to wash hands/
alcohol rub. Its everyone's responsibility