dalin healthcare associated infection

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Infection Control of

Healthcare Associated InfectionBoerhan Hidayat

Infection control committee

Dr.Soetomo General HospitalSurabaya


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What are hospital infections?

Two types of infections youfind in the hospital

Hospital-acquired infections

Community-acquired infections

How can we distinguishthem?

By latency period

CDC definition for NIs:development of infectionsafter 48 hours of admission


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What kinds of hospital infections exit?

Device-related

Blood stream infections (BSI)

Urinary tract infections (UTI)

Ventilator-associated pneumonia (VAP)

Procedure-related

Surgical site infections (SSI)

Environmental contamination

Water, disinfectant, etc.


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Why do we need to study hospital

infections?Not all hospital infections arepreventable, but they are associated

with Excess length of hospital stay

Excess cost

Excess mortality

Law suits


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Distribution of hospital infections by sites,

SENIC study


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Increases in the mean length of hospital stay due to

hospital infections

in the U.S. , SENIC study


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Excess cost of hospitalization due to hospital

infections in the U.S., 1992


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Who are at risk for acquiring hospital

infections?

Patients in Intensive Care Units ICU medical, surgical, burn, Neonatal

ICUPediatric ICU) Surgery department

Immunocompromised patients Cancer treatment, transplant, HIV

infections

Other factors Age, smoking, chronic diseases


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Distribution of hospital infections by infection

sites and endemic/outbreak status

Endemic

Outbreak


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Nosocomial Pathogens By Infection Type

Pneumonia UTI BSI SSI

S. Au reus 19% 2% 16% 20%

Coag (-) staph 2% 4% 31% 14%

Enterococcus 2% 16% 9% 12%

Pseudomonas 17% 11% 3% 8%

Other gram (-) 29% 45% 17% 23%

C. albicans


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Host

Agents

Environment

Infection control

Nutrition

Vaccination

Hand washing

IPD

Environm. manag

(Biol & Non-Biol)

Waste

Aseptic

Antibiotics

Eradication


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Key Prevention Strategies

Prevent infection

Diagnose and treatinfection effectively

Use antimicrobials

wisely

Prevent transmission

Clinicians hold the solution!


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TYPES BY ORIGIN

1.Endogenous:Caused by the organisms that are present

as part of normal flora of the patient

2. Exogenous:Caused by organisms acquiring by exposur

to hospital personnel, medical devices orhospital environment


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Chain of Infection

+

Quantity ofpathogen

Virulence Route oftransmission

Sensitivehost

Port


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Transmission Of Infectious Agents In All Settings

Requires 3 Interrelated Elements

Source

Mode ofTransmission

SusceptibleHost


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MIKROORGANISM (AGENT)

BACTERIA

VIRUSES

FUNGI

PARASIT

RICKETTSIA PROTOZOA

PATHOGENESITYVIRULENCEINVASIONNUMBER

Flora:

Transient Resident


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VIRULENCE

SEVERITY OF DISEASES

MORBIDITY MORTALITY TRANSMISSION LEVEL

INVASIVE ORGANISMINTACT TISSUE(SKIN, MUCOSE, ECT)

NUMBER OF BACTERIA


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Epidemiologically Important Organisms

Antibiotic-resistant organisms such asmethicillin-resistant Staphylococcus

aureus (MRSA), vancomycin-resistantEnterococcus (VRE), and multidrug-resistant gram-negative bacilli arebeing isolated with increasing

frequency* Clostridium difficile has been

increasing in many US hospitals*NNIS Report 1992-2000. Am J Infect Control 2000;28:429.


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S. aureus

Penicillin

[1950s]

Penicillin-resistant

S. aureus

Evolution of Drug Resistance inS. aureus

Link to: CDC Facts about VISA Link to: CDC Facts about VRE

Methicillin

[1970s]

Methicillin-resistant

S. aureus (MRSA)

Vancomycin-resistant

enterococci (VRE)

Vancomycin

[1990s]

[1997]

Vancomycin

intermediate-resistant

S. aureus

(VISA)

[ 2002 ]Vancomycin-

resistantS. aureus

Link to: MMWR on VRSA
http://www.cdc.gov/ncidod/hip/vanco/vanco.htmhttp://www.cdc.gov/ncidod/hip/Aresist/vre.htmhttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm5126a1.htmhttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm5126a1.htmhttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm5126a1.htmhttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm5126a1.htmhttp://www.cdc.gov/ncidod/hip/Aresist/vre.htmhttp://www.cdc.gov/ncidod/hip/vanco/vanco.htm


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Pandemic MRSA clonesUK (42%)

Australia

(30%)

Latin

America(29%)

USA

(36%)

Africa

Nigeria (21%)

Zimbabwe (43%)

South Africa (49%)

Taiwan (61%)

Japan (74%)

Denmark/Norwegian

Netherlands (


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Vancomycin-resistant Enterococci

Nosocomial Isolates in EuropeNosocomial Isolates in the USA


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New Resistant Bacteria

Emergence of AntimicrobialResistance

Susceptible Bacteria

Resistant Bacteria

Resistance Gene Transfer


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Antimicrobial Resistance:

Key Prevention Strategies

OptimizeUse

Prevent

ransmission

Prevent

Infection

EffectiveDiagnosis& Treatment

PathogenAntimicrobial-Resistant Pathogen

AntimicrobialResistance

Antimicrobial Use

Infection

Susceptible Pathogen


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Transmission of Infectious Agents in Healthcare

Settings

Individuals are exposed to human sources ofmicroorganisms by three primary routes:

Contact transmission Direct organism is transferred directly from one person to

another, e.g. scabies or herpetic whitlow Indirect- organism is transferred through contaminated

intermediate object or person, e.g. hands or contaminatedpatient care equipment

Droplet Transmission- relatively large ( >5 microns) dropletheavy with moisture that are propelled relatively short distances

from the source (3-6 feet) onto the mucous membranes of the nose,mouth or eyes, of the host and environmental surfaces

Airborne Transmission- droplet nuclei (


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Routes of Transmission

Respiratory Cough

Sneeze

Fecal-oral Feces contaminate food, environment, or

hands

Vector-borne Transmitted by insects


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Transmission of Influenza Viruses

SeasonalInfluenza in

Humans

Current AvianInfluenza in Humans

Droplet most likelyroute

possible

Airborne possible atclose distances

possible at close

distances

Contact possible Most likely

(bird to human), and

possible (human to

human)


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Chain Model of Infectious Disease

Control Points

RespiratoryHygiene/Cough Etiquette

Education Cover coughs, using tissue

or surgical mask Hand hygiene Spatial separation

Standard precautions Handwashing Personal Protective

Equipment

Standard Precautions(continued)

Patient Placement

Safe work practices

Medical waste handling

Environmental cleaning anddisinfection

Expanded precautions:- Contact

- Droplet

- Airborne infection isolation

- Empiric

Interrupt TRANSMISSION In Healthcare(Including Home And Community Treatment) Settings:


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Goals for infection control and hospital

epidemiology

There are three principal goals for hospitalinfection control and preventionprograms:

1. Protect the patients

2. Protect the health care workers, visitors,and others in the healthcare environment.

3. Accomplish the previous two goals in acost effective and cost efficient manner,whenever possible.

.

M i T k f I f ti


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Main Task of Infection

Control Committee

Develop policies

Training andeducations

AdvocacySurveilance

Reporting and

recommendation

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INFECTIONCONTROL

For the management

and

Departments concerned


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Problems Identification

&

Risk Factors

Analyse

Recommendation

Monitoring & Evaluation

Implementation

Surveillance

Reporting

Evaluation

Advocacy

&

Quality

Control

Advocacy&

QualityControl

Working CapacityOf ICC


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Conclusions

Infection control is very essential toreduce the HAI

Not all HAI can be prevented, but they

are associate with LOS, cost, mortality andlaw suit

Infectious Disease Control Points

Contain the source Interrupt transmission

Reduced susceptibility of the host

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