HOSPITAL ACQUIRED (NOSOCOMIAL) INFECTION jschangco,icn 2003

DEFINITION: ANY INFECTION ACQUIRED BY A PATIENT IN HOSPITAL.

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

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%)

Classification of surgical procedures Clean no entry into GI/GU/Resp tract low risk infection usually exogenous Clean contaminated no significant spillage e.g. cholecystectomy infection rates 5-10 % Contaminated Significant spillage of bacteria expected Infection rate 18-20% Dirty Perforated viscus drainage of abscess Infection rate often >30%

IMPORTANT CROSS-INFECTION ORGANISMS

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.

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

TUBERCULOSIS Open pulmonary TB (Sputum smear positive for AFB) VIRAL INFECTIONS Chicken Pox (Hepatitis B HIV)

RESISTANT GRAM NEGATIVE ORGANISMS Resistance to multiple antibiotics Organisms: E.coli Proteus Enterobacter Acinetobacter Pseudomonas aeruginosa

Cause: Bacteraemia U.T.I. Pneumonia Wound infection Control: Antibiotic Policy Control of Infection Guidelines Prevention of Cross Infection especially on high risk areas

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 patients ICN reviews ICN visits wards

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%

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;2:1315 Ojajarvi J J Hyg 1980;85:193

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

Why Don’t Staff Wash their Hands (Compliance estimated at less than 50%)

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)

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

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)

Successful Promotion  Reminders in the workplace Promote and facilitate skin care Avoid understaffing and excessive workload; Nursing shortages have caused

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

Hand Hygiene Techniques 1.Alcohol hand rub 2.Routine hand wash seconds 3.Aseptic procedures 1 minute 4.Surgical wash 3-5 minutes

Repeat procedures until hands are clean Routine Hand Wash

Alcohol Hand Rubs Require less time Can be strategically placed Readily accessible Multiple sites All patient care areas

Alcohol Hand Rubs Acts faster Excellent bactericidal activity Less irritating (??) Sustained improvement

Alcohol Hand Rubs Choose agent carefully: –Adequate antimicrobial efficacy –Compatibility with other hand hygiene products

Visible soiling Hands that are visibly soiled or potentially grossly contaminated with dirt or organic material MUST by washed with liquid soap and water

Areas Most Frequently Missed HAHS © 1999

Hand Care Nails Rings Hand creams Cuts & abrasions “Chapping” Skin Problems

Hand hygiene is the simplest, most effective measure for preventing hospital-acquired infections.

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

Any Questions??? Thank you for not asking!!!

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