1. HOSPITAL INFECTIONS
Norazli Ghadin

2. 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

3. 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.

4. Commonly occurring Microorganisms in Hospital Infections

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

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

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

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

9. Gastro Intestinal Infections
Salmonella serotypes
Clostridium difficile
Norwalk like viruses

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

11. 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.

12. 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).

13. 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

14. Routes of Transmission of Infection

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. Prevention measures

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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. Others

31. 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

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

33. 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.

34. 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

35. 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.