Download - Hospital infection
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PREVENTION OF HOSPITAL AQUIRED INFECTION
Presented By:
Dr.P.P.Singh
Ex.MEDICAL SUPRINTENDENT HRH &SDN HOSPITAL
Ex.Director Project IPP-VIII
Municipal Corporation of Delhi
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Dr. P.P.SINGH
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Dr. P.P.SINGH
1. CSSM 3. CARE OF WOMEN
FOR RTI/STI(AIDS)
2. FAMILY PLANING
4. ADOLESCENT HEALTH
RCH
WHOLESTIC LIFECYCLE APPROACH TO
WOMEN HEALTH
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Dr. P.P.SINGH
Definition
• Infection acquired by the patients from hospital facilities i.e.
- during hospitalisation
- due to any therapeutic / diagnostic procedures
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Dr. P.P.SINGH
Sources of Hospital Infections
• Cross Infection
• Self or auto infections
• Environmental
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Dr. P.P.SINGH
Prevalence of Hospital Acquired Infection • In early seventies Barrett Connor
Estimated 3-13%• Estimate in USA
Around 1.5 million cases of 5-20% and operative infections 4.7 to 21.8% with an average of 9.7%
• WHO
Estimated after study in 47 countries 3-21% with mean of 8.4%
• India
Authenticated data not available.
References of few hospitals indicate around 10%
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Dr. P.P.SINGH
Aetiology• Like any other disease Process Hospital Infection has
also got epidemiological triad i.e. the agent, host and environment
• Entire spectrum of microbes i.e. bacteria, viruses, ricketsis, fungi and protozae etc. responsible for hospital infection
• 20-25% of all Hospital Infections due to Gram +ve Organisms
• Proteous, e-coli, salmonella, klebsiella, pseudomonas are on the rise
cont.
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Dr. P.P.SINGH
Risk Factors
• Patient factors:• Extreme age
• Malnutrition
• Immune deficiency
• Injuries
• Diseases like Diabetes, Nephritis, Severe burns
• Endogenous infection
cont.
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Dr. P.P.SINGH
• Microbial factors:•High conc. Of agent
•High level of virulence
•Emergence of resistant strains
•Presence of new organism
• Environmental factors:•Level of contamination
•Medical interventions
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Dr. P.P.SINGH
Pathogenic Organisms • Gram Positive
– Staphylococcus
– Streptococcus
– B.subtalis
• Gram Negative– E.coli
– Pseudomonas
– Proteus
– Klebsiella
– Citrobacter
– Shigella
– Salmonella
– Serratia
• Virus– Hepatitis A,B,C…
– HIV/AIDS
– Dengue
– Japanese encephelitis
• Rickettesial– Typhus
– Scrub fever
• Protozoal– Malaria
– Amoebiasis
• Mycobacterial– Tuberculosis
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Dr. P.P.SINGH
Modes of transmission
• Contact spread– Contaminated inanimate objects
• catheters• Cystoscopes• Bed pans etc.
– Person to person & Droplet infection• Infective Hepatitis
• Streptococcal Pharyngitis
Cont.
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Dr. P.P.SINGH
• Common Vehicle Spread– Transmission through food
• Salmonella
– through blood and blood products & Injections and intravenous fluids • Hepatitis B & C
• HIV / AIDS
• Gram -ve Septicemia
• Salmonellosis
Cont.
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Dr. P.P.SINGH
• Airborne spread– Vaccum cleaners & Dust Particles
• Staphalococcal infection
• Tuberculosis
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Dr. P.P.SINGH
• Vector Borne Spread– Body parts of vectors like
• Mosquitoes
• Flies
• Flea
• Bugs
• Cockroaches
Transmit Infections like» Gastroenteritis
» Yersina pestis
» Malaria
» Dengue
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Dr. P.P.SINGH
Types of Hospital Acquired Infection• Urinary tract infections
• Lower respiratory tract infections
• Surgical wound infections
• Anaerobic bacteriological infections
• Gastroenteritis
• Transplant associated infections
• Intravenous cannula related infections
• Intracardiac & various prosthesis infections
• Perpureal infections
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Dr. P.P.SINGH
High Risk Procedures for HAI
• Injections
• Surgical Procedures
• Dressing of wounds
• Management of deliveries
• Investigative procedures
• Laboratory investigations
• Dialysis
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Dr. P.P.SINGH
High Risk Areas for HAI• Haemodialysis Unit
• Intensive Care Unit
• Nursery Unit
• Pharmacy
• Dietetics services
• Laundry
• Operation Theatre
• O.P.D.
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Dr. P.P.SINGH
Management of HAI• HAI Control Committee (meeting once a month)
– Chairman - Medical Superintendence– Member Secretary - Infection Control Officer
(Microbiologist)– Members - Head of all clinical units
- Chief of blood bank- Microbiologist- Medical record officer- Chief of nursing services- Infection control sister
– Invited Members - Chiefs of all supportive services Cont.
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Dr. P.P.SINGH
• Surveillance of HAI
• Sterilisation and high level disinfection
• Proper discarding and disposal of hospital waste
• Universal blood and body fluid precautions by health care workers
• Dietetics services
• Laundry
• Antibiotic policy
• In-service training
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Dr. P.P.SINGH
Universal Precautions• Wash hands before and after patient contact
• Wear gloves for contact with blood & body fluids
• Wear masks to protect against aerosols & splashes
• Wear gowns to protect against splashes
• Handle and dispose sharps safely
• Disinfect and sterilise critical items
• safe disposal of waste
• Hepatitis B vaccination
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Dr. P.P.SINGH
Safe Handling & Disposal of Sharps
• Always dispose of your own sharps
• Never pass sharps directly from one person to other
• The risk of injury in high risk areas should be minimised by ensuring best possible visibility for operator
• Protect fingers from injuries by using forceps while suturing
• Locate sharps disposable container close to the point of use
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Dr. P.P.SINGH
Infection Control Indicator Checklist• Handle sharps safely to minimise injury
– Appropriate puncture proof sharps container– Container less than three quarter full– Sharps not protruding from container– No recapping or one hand recapping of needle & syringe
• Instrument decontaminated fully– Steriliser available and in good working order– Equipment thoroughly cleaned after use– Clean instruments stored in cupboards
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Dr. P.P.SINGH
• Hands washed appropriately to prevent cross infection– Soap and clean water available– Clean towels available– Staff wash & dry hands after contact with body fluid, removal
of gloves and contact with patients
• Protective barrier worn to prevent blood exposure Depending on the clinical area and risk of exposure use
• Disposable gloves
• Heavy duty gloves
• Masks
• Aprons
• Protective eye wears
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Dr. P.P.SINGH
• Waste disposal safety– Evidence of deep burial or incineration regularly– No contaminated waste visible
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Dr. P.P.SINGH
Cost related to HAI• The outbreak infections are expansive. The cost
increased can be summarised as – Prolonged patient stay– Increase consumption of disinfectants– Increase use of protective clothing– Increase in overhead expanses– Cost associated with patient screening– Need for expansive antibiotic therapy
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Dr. P.P.SINGH
HIV / AIDS
PROBLEM IN DELHI. 35000 HIV +Ve.
780AIDS Cases.
PROBABLE SOURCE
•HETRO SEXUAL 75%
•INJECTABLES 7.3%
•RECIPIENT OF BLOOD 7.5%
•OTHER 11%
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Dr. P.P.SINGH
AWERNESS A ACQUIRED ADULT HOOD(Education)
INFORMATION I IMMUNO INJECTABLES
DRUGS(PRE) D DEFFICENCY DRUGS(Disinfectants)
SAFE SEX S SYNDROME SEX
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Dr. P.P.SINGH
RNA Virus
Reverse transcription
HIV1 &HIV2
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Dr. P.P.SINGH
Common cold 5 – 15 years
Death
6-8 wks
Anti bodies
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Dr. P.P.SINGH
RISKS.
Needle stick/prick injury--- 0.25 to 0.3% for HIV, 9 to 30% for HBV, 3-10% for HCV
0.3% risk through muco -cutanious exposure
0.6% IN NON SURGICAL.
4% IN SURGICAL, HIGER IN GYNAECOLOGIST
5 / 1000 IN OTHERS
40% WHILE SUTURING.
60% RECAPPING.
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Dr. P.P.SINGH
ANTISEPTICS
HIV1&2 Hp B
H2O2 0.3 3 %
ALCOHOL 50% 95%
FORMALINE 0.5% 1%
LYSOL 2% 3%
BLEACH 1% 5%
GLUTERALDEHYDE 2% 2%
ULTRA VIOLET LIGHT- HIGHER DOSE
LAMINAR FLOW, OT, LAB.
DRYCLEANNING MAY NOT INACTIVATE
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Dr. P.P.SINGH
MISCONCEPTIONS
MOSQUITO BITE
ANY INSECT BITE
CASUAL CONTACT WITH AIDS pt.
WITH IN HOUSE HOLD
SHARING FOOD, WATER, CLOTHS OR TOILETS
PROFESSIONAL CONTACT.
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Dr. P.P.SINGH
METHODS OF PREVENTION AMONGST HEALTH PERSONNEL
1. KNOWLEDGE, ATTITUDE,PRACTICE. Barrier precautions, Aseptic precautions Management of parenteral &MM exposure to blood/blood products, tissue
organs.2. HAND WASHING WITH SOAP 10 -15 SECONDS 3. WEAR GLOVES – BOTH HANDS, WASHING HAND AFTER
REMOVING GLOVES.4. WEAR EYE GLASSES, FACE SHIELD ,APRON /GOWANS5. DECONTAMINATION / DISINFECTING –
INSTRUMENTS,GLOVES,LINEN ALL THINGS WITH BLEACHING POWDER -15 gms /liter.- SURFACE – 10% BLEACH
5. BIO MEDICAL WASTE ( BMW).6. P.E.P.
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Dr. P.P.SINGH
• SALIVA as source.
- Mouth piece.
- Resuscitation Bags
-Ventilation devices
- Suction machines
-Mouth to Mouth Breathing
• HOSPITAL DISINFECTANT- Chlorine – 1-1.5%
Sod. Hypochlorite 1 gm/L
Calcium hypochlorite 1.4 gm/L
Bleach at least 10 min.
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Dr. P.P.SINGH
HANDLING SPECIMENSUSE GLOVES
SCREW CAPPED LEAK PRFOOF CONTAINERS
CARE TAKEN WHILE TRANSPORT OF SAMPLES.
SERA CAN BE KEPT - - HEAT 56 0 C FOR 30 MIN.
NO MOUTH PIPETTINGS
ANY SPILLAGE OF BLOOD & OTHER BODY FLUIEDS ON TABLE TOP OR ANY SURFACE – CLEAN WITH SOD. HYPOCHLORITE.
ALL OPEN WOUNDS ON HAND & ARMS SHUOLD BE COVERED
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Dr. P.P.SINGH
ASEPTIC PRECAUTIONS
(IN RELATION TO INJECTION / OTHER SKIN PIERCING
PROCEDURES)
REDUCE UNECESSARY USE.
SINGLE USE DISPOABLES
REUASBLE SHOULD BE DIS INFECTED ,WASHED , & STERILISE
PUNCTURE PROOF CONTAINERS
P E P – ANY NEEDLE STICK , INJURY , CUTS OR MUCUS MEMBRAIN EXPOSURE.
- WASH PROPERLY
- BLEEDING IS ENCOURAGED
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Dr. P.P.SINGH
NON INVASIVE PROCEDURES
VAGINAL & RECTAL EXAMINATION.
INTRA OCCULAR PRESSURE
CONTACT LENSES TRIAL.
TRACHIAL & LARYNGIAL EX.
THROAT & NASAL EX.
X RAY & CT SAN ETC,
- THERE IS CHANCES OF BREAK OF MM.
- BODY FLUIDS / SECRETION MAY ACT AS SOURCE OF INFECTION.
*** EFFECTIVE USE OF STERILISATION & DISINFECTANTS
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Dr. P.P.SINGH
Conclusion• Prevention of Hospital Infection will cut the wasteful
expenditure. Savings could be re-deployed for betterment of hospital
• Incidence of Hospital Acquired Infection can be reduced to great extent by– Work culture & attitude of health care providers– Religious observation of universal precautions– Application of antiseptic technique– Proper Disposal of hospital waste