HOSPITAL INFECTIONS

HEALTH CARE SOLUTIONS

Dr.T.V.Rao MD

DR.T.V.RAO MD

MICROBIOLOGY - SCIENTIFIC ERA INFECTION

Anton van Leeuwenhoek (1632-1722)
Dutch linen draper Amateur scientist Grinding lenses, magnifying glasses, hobby First to see bacteria little beasties

No link between bacteria and disease

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SCIENTIFIC ERA CONTINUED . . . . .

Ignaz Semmelweis (1818-1865)

Obstetrician, practised in Vienna Studied puerperal (childbed) fever Established that high maternal mortality was due to failure of doctors to wash hands after postmortems
Reduced maternal mortality by 90% Ignored and ridiculed by DR.T.V.RAO MD colleagues

SCIENTIFIC ERA CONTINUED . . ...

Louis Pasteur (1822-1895)

French professor of chemistry Studied how yeasts (fungi) ferment wine and beer Proved that heat destroys bacteria and fungi

Proved that bacteria can cause infection the germ theory of disease
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SCIENTIFIC ERA CONTINUED

Robert Koch (1843-1910)
German general practitioner Grew bacteria in culture medium Showed which bacteria caused particular diseases Classified most bacteria by 1900
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HOSPITAL ACQUIRED INFECTION

Infection which was neither present nor incubating at the time of admission Includes infection which only becomes apparent after discharge from hospital but which was acquired during hospitalisation.

Also called nosocomial infection

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WHAT ARE HEALTH CARE ASSOCIATED INFECTIONS

Healthcare associated infections (HCAIs) are infections transmitted to patients (and healthcare workers) as a result of healthcare procedures, in hospital and other healthcare settings. Recent years have seen an increase in the awareness of HCAIs, in particular those caused by antibiotic-resistant
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superbugs

WHAT ARE HEALTH CARE ASSOCIATED INFECTIONS ???

A wide variety of microorganisms can cause HCAIs, leading to an extensive range of different diseases. Experts estimate that 9% of in-patients have an HCAI at any one time.
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HEALTH CARE ASSOCIATED INFECTIONS AND MICROBES

HCAIs are mostly caused by bacteria. Bacteria can
exist harmlessly in people, for example on the skin or in the gut. However, some types of bacteria can cause HCAIs when they enter the body, for example through wounds and the use of surgical devices, or when the bodys natural balance is disturbed. HCAIs occur in the lungs (23% of all HCAIs), urinary tract (23%), blood (6%), skin (11%) and gut. Infections are usually treated with antibiotics. However, many bacteria have developed resistance to antibiotics This can make infections harder to treat.
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INCREASED USE OF ANTIBIOTICS

Increasing antibiotic use. The more antibiotics are being used, the more likely bacteria become resistant to them. Antibiotics are sometimes prescribed for conditions that are not treatable with antibiotics, such as colds and the flu.
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ANTIBIOTIC RESISTANCE
Not a new problem - Penicillin in 1944 Hospital superbugs Methicillin Resistant Staphylococcus Aureus [MRSA] Vancomycin Intermediate Staphylococcus Aureus [VISA] Tuberculosis - antibiotic resistant form
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IRREGULAR USE OF ANTIBIOTICS

Patterns of antibiotic use. Many people do not finish their courses of antibiotics because they start feeling better. This means that bacteria are not killed off, so they multiply, become resistant and transmit to others.
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THE NATURE OF INFECTION

Micro-organisms - bacteria, fungi, viruses, protozoa and worms
Most are harmless [non-pathogenic] Pathogenic organisms can cause infection

Infection exists when pathogenic organisms enter the body, reproduce and cause disease
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HOSPITAL ACQUIRED INFECTION

Infection which was neither present nor incubating at the time of admission Includes infection which only becomes apparent after discharge from hospital but which was acquired during hospitalisation

Also called Nosocomial infection

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Two sources of infection:

MODES OF SPREAD

Endogenous or self-infection - organisms which are harmless in one site can be pathogenic when transferred to another site e.g., E. coli Exogenous or cross-infection - organisms transmitted from another source e.g., nurse, doctor, other patient, environment (Peto, 1998)
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USE OF LEFTOVER ANTIBIOTICS Using leftover antibiotics to selfmedicate against a fresh infection can exacerbate the problem, as specific bacterial infections require specific antibiotics
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USE OF ANTIBIOTICS IN LIVESTOCK

The indiscriminate use of antibiotics in livestock has further compounded the problem by increasing the likelihood of resistance factors emerging.
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CONCERNS WITH STAPHYLOCOCCUS

Methicillin-resistant S. aureus (MRSA) is resistant to several antibiotics. Another form of S. aureus, vancomycin-resistant S. aureus (VRSA), is resistant to one of the most powerful, last line of defence antibiotics, vancomycin
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RESISTANT GRAM NEGATIVE ORGANISMS

RESISTANCE TO MULTIPLE ANTIBIOTICS
ORGANISMS: E .COLI PROTEUS ENTEROBACTER ACINETOBACTER PSEUDOMONAS AERUGINOSA

E.COLI AND EMERGING RESISTANCE

Escherichia coli (E. coli) has gradually become resistant to different types of antibiotics. In 2003, the overall resistance of E. coli to common amino penicillin antibiotics reached 47% across Europe
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PSEUDOMONAS AERUGINOSA
Pseudomonas aeruginosa (P. aeruginosa) and Extended Spectrum Beta Lactamase (ESBL) -producing bacteria are increasingly becoming resistant to antibiotics.

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OBJECTIVES REDUCING INFECTIONS

Reducing infection rates

Establishing endemic baseline rates

Identifying outbreaks Identifying risk factors Persuading medical personnel Evaluate control measures Satisfying regulators Document quality of care Compare hospitals NCI rates
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SURVEILLANCE
Important means of monitoring HAI Early detection of trends outbreaks
. Laboratory Based Microbiology Laboratory lists +ve organisms ICN reviews Alert organisms reported

2. Ward Based

Ward staff monitor patients ICN reviews ICN visits wards

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WHO WILL PRACTICE PREVENTIVE MEASURES

All hospitals? All departments? All specialties? Other health institutions?
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Stakeholders
Central adm. .. Local adm. Public Health instituteI ICP

Directorat

Surveillance of surgical site infections

Itdep.

Ministry Of health

Surgical wards

Service dep.

Surgical ward. 2

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Lab

Patients

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 PPE when contamination or splashing with blood or body fluids is anticipated Disposable gloves Plastic aprons Face masks Safety glasses, goggles, visors

PERSONAL PROTECTIVE EQUIPMENT

Head protection
Foot protection

Fluid repellent gowns

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 Hand washing

UNIVERSAL PRECAUTIONS

Personal protective equipment [PPE]

Preventing/managing sharps injuries

Aseptic technique Isolation

Staff health
Linen handling and disposal Waste disposal

Spillages of body fluids

Environmental cleaning Risk management/assessment
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Why Dont Staff Wash their Hands

(Compliance estimated at less than 50%)
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HAND WASHING
Single most effective action to prevent HAI resident/transient bacteria Correct method - ensuring all surfaces are cleaned more important than agent used or length of time taken

No recommended frequency - should be determined by intended/completed actions

Research indicates: poor techniques - not all surfaces cleaned frequency diminishes with workload/distance poor compliance with guidelines/training
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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)
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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
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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)

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SUCCESSFUL PROMOTION
Reminders in the workplace Promote and facilitate skin care Avoid understaffing and excessive workload; Nursing shortages have caused
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AREAS MOST FREQUENTLY MISSED

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HAHS 1999

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 Nails Rings Hand creams Cuts & abrasions Chapping Skin Problems
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HAND CARE

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

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SHARPS INJURIES
Prevention

correct disposal in appropriate container

avoid re-sheathing needle avoid removing needle discard syringes as single unit avoid over-filling sharps container

Management
follow local policy for sharps injury (May, 2000)

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 Clinical waste - HIGH risk

WASTE DISPOSAL

potentially/actually contaminated waste including body fluids and human tissue yellow plastic sack, tied prior to incineration Household waste - LOW risk paper towels, packaging, dead flowers, other waste which is not dangerously contaminated black plastic sack, tied prior to incineration Follow local policy (May, 2000)
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SPILLAGE OF BODY FLUIDS

PPE - disposable gloves, apron

Soak up with paper towels, kitchen roll

Cover area with hypochlorite solution e.g., Milton, for several minutes Clean area with warm water and detergent, then dry

Treat waste as clinical waste - yellow plastic sack

Follow local policy
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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%

JOURNAL OF INFECTION PREVENTION

Journal of Infection Prevention is the professional publication of the Infection Prevention Society. The aim of the journal is to advance the evidence base in infection prevention and control, and to provide a publishing platform for all health professionals interested in this field of practice. The journal is a bi-monthly peer-reviewed publication containing a wide range of articles: Original primary research studies, Qualitative and quantitative studies,.
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CONSEQUENCES OF HOSPITAL INFECTIONS ???

Hospital

Pathogen

Unhappy patients

Unhappy director

Hospital
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Surveillance

Happy Patients

Happy director 42

Programme created by Dr.T.V.Rao MD for Medical and Paramedical Professionals in the Developing World
Email doctortvrao@gmail.com

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