COMMON HOSPITAL- ACQUIRED

INFECTIONSHumbert Simon A. Dumagat RN, MAN

OBJECTIVES:At the end of the 15-minute presentation, the PhD students will be able to:1. Discuss what is Hospital-Acquired Infection.2. Utilize the different bundles of care to prevent

hospital-acquired infection when they go to the clinical area.

3. Analyze if hospital-acquired infections can be minimized using the current bundles of care.

4. Recommend other nursing interventions that can help reduce the incidence of hospital-acquired infection.

HOSPITAL-ACQUIRED INFECTIONAn infection acquired in the hospital by a patient who was admitted for a reason other than that infection.

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 (Ducel, Fabry & Nicole, 2002).

Infections occurring more than 48 hours after admission are usually considered nosocomial.

FACTORS INFLUENCING THE DEVELOPMENT OF

NOSOCOMIAL INFECTIONS1. The microbial agent - Many different bacteria, viruses, fungi

and parasites may cause nosocomial infections.

2. Environmental factors - Microbial flora may contaminate objects,

devices, and materials which subsequently contact susceptible body sites of patients.

FACTORS INFLUENCING THE DEVELOPMENT OF

NOSOCOMIAL INFECTIONS3. Patient susceptibility - age, immune status, underlying disease, and

diagnostic and therapeutic interventions may influence patients susceptibility to infection.

4. Bacterial resistance - Through selection and exchange of genetic

resistance elements, antibiotics promote the emergence of multidrug resistant strains of bacteria.

DISEASES AND ORGANISMS IN HEALTHCARE SETTINGS (CDC,2016)

Acinetobacter Burkholderia cepacia Clostridium difficile Clostridium sordellii Enterobacteria Gram-negative bacteria Hepatitis Human Immunodificiency Virus (HIV)

Influenza

Klebsiella Methicillin-resistant Staphylococcus aureus (MRSA)

Mycobacterium abscessus Norovirus Pseudomonas aeruginosa Staphylococcus aureus Tuberculosis (TB) VISA/VRSA Vancomycin-resistant Enterococci (VRE)

TYPE OF HOSPITAL-ACQUIRED INFECTIONS

Central Line-associated Blood Stream Infection (CLABSI)

- Primary BSI in a patient that had a central line within the 48-hour period before the development of the BSI and is not bloodstream related to an infection at another site (CDC,2016)

TYPE OF HOSPITAL-ACQUIRED INFECTIONS

Catheter-associated Urinary Tract Infection (CAUTI)- A urinary tract infection (UTI) is an infection involving any part of the urinary system, including urethra, bladder, ureters, and kidney. Approximately 75% are associated with a urinary catheter, which is a tube inserted into the bladder through the urethra to drain urine (CDC,2016).

TYPE OF HOSPITAL-ACQUIRED INFECTIONS Surgical Site Infection(SSI)

- A surgical site infection is an infection that occurs after surgery in the part of the body where the surgery took place. Surgical site infections can sometimes be superficial infections involving the skin only. Other surgical site infections are more serious and can involve tissues under the skin, organs, or implanted material (CDC,2016).

TYPE OF HOSPITAL-ACQUIRED INFECTIONSHospital Acquired Pneumonia (HAP)

- Pneumonia that occurs 48 hours or more after admission. - Not incubating at the time of admissionVentilator-associated Pneumonia (VAP)

- Develops more than 48 to 72 hours after intubation.

Healthcare-associated pneumonia (HCAP) - Pneumonia in a non-hospitalized patient - With extensive healthcare contact

CLABSI BUNDLES OF CAREEducation, Training and Staffing Selection of Catheters and Sites Hand Hygiene and Aseptic Technique Patient Cleansing Catheter Securement Devices Antimicrobial/Antiseptic Impregnated Catheters and Cuffs Antibiotic/Antiseptic Ointments Antibiotic Lock Prophylaxis, Antimicrobial Catheter Flush and Catheter Lock Prophylaxis

CAUTI BUNDLES OF CARE Appropriate Urinary Catheter Use Proper Techniques for Urinary Catheter

Insertion Proper Techniques for Urinary Catheter

Maintenance Quality Improvement Programs Administrative Infrastructure Surveillance

WHAT CAN PATIENTS DO TO HELP PREVENT CAUTI?

Patients with a urinary catheter can take the following precautions to prevent CAUTI:

Understand why the catheter is needed and ask the healthcare provider frequently if the catheter is still needed.

If the patient has a long-term catheter, they must clean their hands before and after touching the catheter.

Check the position of the urine bag; it should always be below the level of the bladder.

Do not tug or pull on the tubing. Do not twist or kink the catheter tubing.

VAP BUNDLES OF CAREEight practices: hand hygiene, glove and gown compliance, elevation of the head of the bed, oral care with chlorhexidine, maintaining an ET cuff pressure >20 cm H20, orogastric rather than nasogastric feeding tubes, avoiding gastric over distention, and eliminating nonessential tracheal suctioning

Five interventions: semirecumbent position, stress ulcer prophylaxis, Deep Vein Thrombosis prophylaxis, adjustment of sedation, and daily assessment for extubation.

SSI BUNDLES OF CARE Clipper use Appropriate antibiotics Thermoregulation Sugar intake controlled Chlorhexidine skin prep Hand hygiene OR cleaning Wellness

HOW CAN HOSPITAL ACQUIRED INFECTION AFFECT NURSING?

The nurse is the member of the healthcare team who leads the rest of the team in practicing prevention strategies to protect the patient from infection. Some of the most basic strategies resulting in positive patient outcomes include:  the practice and promotion of hand hygiene  consistent use of aseptic technique  cleaning and disinfection practices  use of standard precautions  patient assessment and additional precautions  patient education  use of safety devices  removal of unnecessary invasive devices  use of bundle strategies for infection prevention

REFERENCES: Ducel, G., Fabry, J. & Nicole, L. (2002) Prevention of hospital-acquired

infections: A Practical Guide. Retrieved from: http://www.who.int/csr/resources/publications/ drugresist/en/whocdscsreph200212.pdf?ua=1

Center for Disease Control and Prevention. (2016). Hospital-acquired infections (HAI). Retrieved from: http://www.cdc.gov/hai/index.html

Benson, S. & Powers, J. (2011). Nursing Made Incredibly Easy!. Retrieved from: http://www.nursingcenter.com/cearticle?tid=1157225