HEALTH CARE ASSOCIATED INFECTION دکترافشین محمد علیزاده متخصص عفونی عضوهیئت علمی دانشگاه علوم پزشکی شهیدبهشتی بیمارستان آیت ا...طالقانی

What is a Nosocomial Infection ? An infection which is acquired during hospitalization and which was not present or incubating at the time of admission An infection which is acquired in the hospital and becomes evident after discharge from the hospital A newborn infection which is the result of passage through the birth canal A surgical site infection(SSI) after less than 30 days. A surgical site infection(SSI) after less than one year from device insertion.

What is a Nosocomial Infection ? Practically - to establish that an infection is hospital acquired, SHOW THAT the patient: 1. HAS AN INFECTION, not a simple colonization 2. WAS NOT infected at the time of admission 3. HAD SUFFICIENT TIME to develop infection

 Patient may acquire infection before admission to the hospital = Community acquired infection.  Patient may get infected inside the hospital = Nosocomial infection.  It includes infections  not present nor incubating at admission,  infections that appear more than 48 hours after admission,  those acquired in the hospital but appear after discharge  also occupational infections among staff. The risk of infection is always present.

True Infection NOT Colonization Infections are accompanied by signs and symptoms:  fever, malaise  in localized infections: swelling due to inflammation, heat, pain, erythema Use definitions which establish minimum characteristics for infection Remember: Immunocompromised patients do not show signs of infection as normal patients. Neutropenic patients (  500 neutrophils /mm3) show no pyuria, no purulent sputum, little infiltrate and no large consolidation on chest X-ray 1 1

NO Infection at Time of Admission establish prior negativity check history, symptoms and signs documented at time of admission, lab tests & chest X-rays done -normal physical examination -absence of signs and symptoms -normal chest X-ray -negative culture or lack of culture Example: If urine cultures are collected at day 7 of hospitalization and none was collected before, it implies that no signs of infection were present in urine before 2 2

Sufficient Time to Develop Infection diseases with specific incubation period: stay in hospital  incubation period numerous infections do not have well set incubation periods (for example, staphylococci, E.coli infections) - these infections rarely develop in less than 2 days 3 3

Blood Stream Infections BSI

Surgical Site Infection SSI

Urinary Tract Infection UTI

Respiratory Tract Infection RTI

Criteria of Nosocomial Infections

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.

Distribution of HCAI Urinary tract infections (27 %). Lower respiratory tract infections including pneumonia (24 %). Surgical site infections (17 %). Bloodstream infections (10.5 %). Others including diarrhoea due to Clostridium difficile. Ref: ecdc.europa.eu

Challenges of HCAI Increased Mortality- “Approximately 4.1 million European patients acquire a HAI annually and 37,000 of these patients die as a direct consequence of their infection”. Increased Morbidity – increased length of stay (4 days per infection). Increased Cost- hospital costs & post discharge costs increased 3 times. Negative impact on the well being of patients % HCAI are preventable. Ref :ecdc.europa.eu

Established in 2005 by the Centers for Disease Control and Prevention (CDC) to integrate the former CDC surveillance systems:  National Nosocomial Infections Surveillance System (NNIS)  Dialysis Surveillance Network (DSN)  National Surveillance System for Healthcare Workers (NaSH) National Healthcare Safety Network NHSN

The NHSN Agreement to Participate and Consent is a user agreement and data consent form required to use NHSN, the recognized gold-standard surveillance system for healthcare-associated infections (HAIs). The document details the purposes of NHSN and data access and protection provisions. Facilities that request NHSN access must have a senior executive review, sign, and return the form to CDC. Instructions are with the form.

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