1. Health Care-Associated Infections in King Faisal Hospital
Christine Mukashema

2. Learning Objectives To be aware about the HCAI problem
Describe principles of control measures

3. What is Health Care-Associated Infections?
Also referred to as “nosocomial” or “hospital” infection
“An infection occurring in a patient during the process of care in a hospital or other health-care facility which was not present or incubating at the time of admission. This includes infections acquired in the health-care facility but appearing after discharge, and also occupational infections among health-care workers of the facility”

4. Why this presentation
HCAI places a serious disease burden and significant economic impact on patients and health-care systems
No health-care facility, no country, no health-care system in the world can claim to have solved the problem

5. Estimated rates of HCAI worldwide
over 1.4 million people suffering HCAI
In developed world:
5–10% of patients acquire one or more infections
In developing countries:
risk of HCAI is 2–20 times higher than in developed countries
exceed 25% of patients affected by HCAI
In intensive care units
30% of patients
44% of attributable mortality

6. Most frequent KCAI in KFH
2011
Klebsiella 
17.6%
Pseudomonas
7.6%
Acinetobacter
5.5%
Staphylococcus Aureus
8.2%
E.Coli
37.7%
Infection rate
9.4%
2012
Klebsiella
19.5%
Acinetobacter:
10.5%
Pseudomonas:
7.6%
Staphylococcus Aureus
7.4%
E.Coli: 34.7%
34.7%
Infection rate
11%

7. Most frequent in KFH The Respiratory tract: Urinary tract:
procedures and equipment associated with intubation, ventilator support and tracheotomy
management of TB…
 Urinary tract:
procedures and equipment associated with urinary drainage systems
indwelling catheters
catheters and their care
Intravascular devices:
procedures and equipment associated with peripheral venous lines, CVCs….
Surgical wounds:
procedures and equipment associated with their care

8. Some HAI in ICU(2011- May2012) SPECIMEN KLEBSIELLA PSEUDOMONAS
ACIENTOBACTER
BLOOD 3 1 2
CSF 4
FLUID 6 22
PUS 9 7
SPUTUM
URINE 8 5
Total 31 18 34

9. Some HAI in Surgical (2011- May 2012)
SPECIMEN
KLEBSIELLA
PSEUDOMONAS
ACIENTOBACTER
BLOOD 5
CSF 1
FLUID 4 6 18
PUS 9 14
SPUTUM 3
URINE 15 8
TISSUE 2
Total 35 34 52

10. Organisms isolated during 8 months by ward
Ward Names
January
February
March
April
May
June
July
August
Total
Percentage
Surgical 19 15 18 30 12 26 22 17
159
33%
ICU 13 10 6 9 1 5 14 68
14%
Medical 16 11 7 23
106
22%
Paediatric 3 77
16%
NICU 2 2%
Urusaro
Maternity 4 21
4.3%
HDU 8 25 5%
Haemodialysis 69 60 49 65 48 59 76 70
485

11. Where we can found those Microbes?
Bed rails
Bedside tables
Ventilators
Infusion pumps
Mattresses
Pillows
Air humidifiers
Patient monitors
X-ray view boxes
Curtain rails
Curtains
Equipment carts
Sinks
Ventilator circuits
Floor mops
HCWs

12. Possible causes of HCAI in KFH
Poor Hand Hygiene
Knowledge of the policies, guidelines/standards
No in ward training
No orientation in the department
High turnover of staff
Lack of staff
Negligence/ignorance
Stock outs / recycling/ lack of instruments
Staff motivation
Cleaning of instruments/ soaking of instruments
Dilution of chemicals used for cleaning- bed area and the instruments
No guideline on screening patients transferred from other institutions
Personal hygiene – staff uniform and cleaning
Labeling and changing of invasive
Isolation Precautions (sometimes not possible)
Use of PPE
Frequent stock outs of IPC items

13. Antibiotic sensitivity
Bad usage of antibiotic causes drug resistance
Not given in
Appropriate time
Appropriate dose
Appropriate course
Appropriate antibiotics

14. Most frequent infection sites & their risk factors
URINARY TRACT INFECTIONS
Urinary catheter
Urinary invasive procedures
Advanced age
Severe underlying disease
Urolitiasis
Pregnancy
Diabetes
34%
13%
LOWER RESPIRATORY TRACT INFECTIONS
Mechanical ventilation
Aspiration
Nasogastric tube
Central nervous system depressants
Antibiotics and anti-acids
Prolonged health-care facilities stay
Malnutrition
Advanced age
Surgery
Immunodeficiency
LACK OF HAND HYGIENE
Most common sites of HCAI and the risk factors
SURGICAL SITE INFECTIONS
Inappropriate antibiotic prophylaxis
Incorrect surgical skin preparation
Inappropriate wound care
Surgical intervention duration
Type of wound
Poor surgical asepsis
Diabetes
Nutritional state
Immunodeficiency
Lack of training and supervision
BLOOD INFECTIONS
Vascular catheter
Neonatal age
Critical care Severe underlying disease
Neutropenia
Immunodeficiency
New invasive technologies
Lack of training and supervision
Central nervous system depressants
17%
14%

15. Hand transmission
Hands are the most common vehicle to transmit health care-associated pathogens
5 sequential steps to transmit of health care-associated pathogens from one patient to another via health-care workers’ hands

16. 5 stages of hand transmission
One
Two
Three
Four
Five
Germs present on patient skin
and immediate environment surfaces
Germ transfer onto health-care worker’s hands
Germs survive on hands for several minutes
Suboptimal or omitted hand cleansing results in hands remaining contaminated
Contaminated hands transmit germs via direct contact with patient or patient’s immediate environment

17. The impact of HCAI HCAI can cause: more serious illness
prolongation of stay in a health-care facility
long-term disability
excess deaths
high additional financial burden
high personal costs on patients and their families

18. Study on the Efficacy of Nosocomial Infection Control (SENIC)
>30% of HCAI are preventable
Relative change in NI in a 5 year period (1970–1975) 10 20 30
-40
-30
-20
-10 %
Without infection control
14% 9%
19%
26%
18%
LRTI
SSI
UTI
BSI
Total
With infection control
-31%
-35%
-27%
-32%
Haley RW et al. Am J Epidemiol 1985

19. Prevention of HCAI At least 50% of HCAI could be prevented
Validated and standardized prevention strategies have been shown to reduce HCAI
Most solutions are simple and not resource-demanding and can be implemented in developed, as well as in transitional and developing countries

20. Possible solutions A proper orientation in all departments
Regular training of staff in IPC
Monthly IPC audit, hand washing audit
Avail all necessary items from the management
Motivation of staff
A proper reporting of infections
Administration to facilitate repair and/or establishment of hand washing facilities in all areas
To put in place some measures if policies/ guidelines are not followed

21. Possible solutions
9. Implementation of IPC policies and guidelines in all department
10. To procure all necessary items and equipments needed
11. To recruit enough nurses
12. To follow policy on the use of antibiotics in the hospital
13. Environmental decontamination
14. The HoU, NUMs should follow closely their staff (close supervision)

22. Why should you clean your hands?
Any health-care worker, caregiver or person involved in patient care needs to be concerned about hand hygiene
Therefore hand hygiene concerns you!
You must perform hand hygiene to:
protect the patient against harmful germs carried on your hands or present on his/her own skin
protect yourself and the health-care environment from harmful germs

23. The “My 5 Moments for Hand Hygiene” approach