HOSPITAL INFECTIONS Norazli Ghadin

What are Hospital acquired infections 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 infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility

How and When Hospital acquired infections occur. Infections are considered Nosocomial if they first appear 48 hours or more after hospital admission or within 30 days after discharge.

Commonly occurring Microorganisms in Hospital Infections

Common sites associated with etiological agents Urinary tract Surgical wounds Respiratory tract Skin (especially burns) Blood (bacteraemia) Gastrointestinal tract Central nervous system

Urinary tract Infections Escherichia coli Klebsiella, Serratia,Proteus spp Pseudomonas aeruginosa Enterococcus spp Candida albicans

Respiratory Infections Haemophilus influenzae Streptococcus pneumonia Staphylococcus aureus Enterobacteriaceae Respiratory viruses Fungi, Candida spp Aspergillus's spp

Skin sepsis and Wounds Staph aureus Streptococcus pyogenes E.coli Proteus spp Anaerobic bacteria Enterococcus spp Coagulase negative Staphylococcus

Gastro Intestinal Infections Salmonella serotypes Clostridium difficile Norwalk like viruses

Risk Factor categorized into 3 areas: iatrogenic, organizational, patient-related

Iatrogenic risk Iatrogenic risk factors include pathogens on the hands of medical personnel, invasive procedures (eg, incubation and extended ventilation, indwelling vascular lines, urine catheterization), and antibiotic use and prophylaxis.

Organizational Organizational risk factors include contaminated air- conditioning systems, contaminated water systems, and staffing and physical layout of the facility (eg, nurse- to-patient ratio, open beds close together).

Patient associated Patient risk factors include the severity of illness, underlying immunocompromised state, and length of stay. Prolonged stay in the hospital is a Major contributing factor crowding

Routes of Transmission of Infection

Air – borne route From respiratory tract via talking, coughing, sneezing From the skin by natural shedding of the skin scales during would dressing or bed making. From aerosols from equipment, respiratory apparatus, air- conditioning plants. Doctorrao’s ‘e’ learning series

Contact spread In direct contact spread from person to person By indirect contact spread via contaminated hands or equipment. Clothing of staff, Urinary catheters, contaminated with hands of the operator may introduce organisms, or patients own flora from urethra may contribute to infection. Doctorrao’s ‘e’ learning series

Food borne spread From hospital kitchen, or in special diets, infant feeds, kitchen, or commercial supplies Mechanical vectors flies, cockroaches or insects, or rodents act as carriers of infection. Doctorrao’s ‘e’ learning series

Blood borne spread The accidental transmission of infections as HIV, HBV,and HCV by needle stick injuries is documented Syphilis and malaria a concern in high prevalence areas

Self Infections and Cross infections Lower bowel surgery, Self infection may occur due to flora from nose, Staphylococcus may be introduced into wounds. Cross infection between patients occur due to spread of Staphylococcus or coli forms

Other contributing factors Not using perfect aseptic technique. Infection from normal flora Defective hospital layout People behavior Cross infection Used of contaminated syringe Antibiotic resistance New pathogen From environment Viral agents

Prevention measures

Hospital governor should form an infection control committee. The committee is consist of Infection control team Infection control nurse

Infection control committee to formulate and update policies for the whole hospital on all matter which have bearing on infection control and to manage outbreaks of Nosocomial infection

Infection Control Team Which will function under the guidance of Infection control Doctor. A Medically qualified Microbiologist, who will take responsibility of day to day for the policies formulated

The Functions of the infection control team To do surveillance and infection monitoring of hygiene practices. Educate the Medical and Paramedical staff on policies relating to prevention of infection, and safe procedures

Infection Control Nurse Is the key member of the team Maintain the close working relations between Microbiology Laboratory, different clinical services and supportive services like laundry, pharmacy and engineering

All are campaigners of Safe practices It is the minimal responsibility of the members to campaign on issues related to safe practices including Hand washing

What to be educate? campaigners of Safe practices Good practice on decontamination & sterilization Aseptic technique procedure Cleaning & disinfection practice Promote staff awareness & training Use of prophylactic antibiotic where applicable

preventive methods other than education Use protective clothing in high risk environment Isolation of source infection & highly susceptible patient (barrier nursing) Sterile room Trexler isolator Personnel healthcare Immunization Preventive steps education

Others

Hospital building and Design Routine maintenance of the Hospital building is important, ensuring that surfaces wherever possible are smooth, impervious and easy to clean. All constructions around the existsting Hospitals generate fungal spores and bacterial spores with have impact on specialized units serving immunocompromised patients

Monitoring of the Environment ? monitoring of the Air conditioning plants, and machinery used for disinfection and sterilization is essential

Surveillance and Role of Microbiology Laboratories The detection and identification of hospital infection incidents or outbreaks rely on the laboratory data that alert the infection control team to unusual cluster of infection, called as ‘alert organism’ system.

Surveillance Identification of MRSA & ESBL and timely information to clinicians will help the ongoing events in the Hospital warrant to track the events on source of outbreaks and action to control the similar situations in future

Efficacy of Infection control The Following measures will certainly control the infections Sterilization Hand washing Closed drainage systems for urinary catheters. Intravenous catheter care Peri operative antibiotic prophylaxis for contaminated wounds, and care of equipment used in respiratory therapy.