HOSPIAL ACQUIRED INFECTION (DEPARTMENT OF COMMUNITY MEDICINE)

Moderated by- Dr. Dhiraj SrivastavaPresented by- Srihari Adhikari

Roll No.- 73Batch- 2010

U.P. RURAL INSTITUTE OF MEDICAL SCIENCES AND

RESEARCH

Definition• Hospital acquired infection / nosocomial

infection are infection acquired during hospital care which are not present or incubating at admission.

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

• Word Nosocomial comes from the greek word nosokomeion meaning hospital (nosos= disease, komeo= to take care of)

Definition by CDC

• Infection that patients acquire during the course of receiving treatment for other conditions or that health workers acquire while performing their duties within healthcare setting

Surgical site infection

• Any purulent discharge or abscess or spreading cellulitis at the surgical site during the month after the operation.

Urinary infection

• Positive urine culture (1 or 2 species) with at least 1o thousand bacteria/ml without clinical symptoms.

Respiratory infection

Respiratory symptoms with at least 2 of the following signs appearing during hospitalization

• Cough• Purulent sputum• New infiltrate on chest

radiograph consistent with infection.

septicaemia

• Fever or rigors and at least one positive blood culture

Vascular catheter infection

• Inflammation, lymphangitis or purulent discharge at the insertion site of the catheter

Special situation that is usually HAI

Infection in neonates that

result from passage

through birth canal

Special situation that are not usually HAIs

Complication or extension of infection(s)

already present on admission unless a change in pathogen

or symptoms strongly suggest

the acquisition of new infection

Infection in an infant that is

known or proven to have been

acquire transplacentally & become evident

before 48 hour of birth

Researches in India

Prospective study in burn unit of a tertiary case referral centre in north india

• Hospital wide study is Performed by Taneja N., Emmanuel R.,Chari P S, Sharma M. in 2004

• 71 patient developed 59 hospital acquired infection.

• Infection density- 36.2 infection per 1000 patient day

• Commonest- invasive wound infection

U.T.I. study in JNMC Aligarh

• Performed by M. Akram, M.Shahid, A U Khan in 2007.

• 100 sample infected out of 920 tested urine sample.

• Infection of E. Coli- 61%Klebsiella – 22%

Hospital acquired infection can be considered from 3 angles

1) Source2) Route of spread 3) recipients

1) SOURCE

• Patient

• Staff

• environment

2) Routes of spread

a) Direct contact b) Droplet infectionc) Air borne particled) Release of hospital dust into the aire) Through various hospital procedure

a) Direct contact

b) Droplet infection

c) Air borne particle

d) Release of hospital dust into

the air

e) Through various hospital procedure like

• catheterization• Intravenous

procedure • dressing • infected cat gut • sputum cups• bed pans• urinals etc.

3) RECIPIENTS

a) Patient especially severely ill & under corticosteroid therapy

b) Cross infection is greater in• Intensive care unit• Urological ward• Geriatric ward• Special baby care unit

PREVENTIVE MEASURES

1) Isolation of infectious patient

2) Hospital staff

• Keep away from work until completely cured

3) Hand washing

WHO guideline for hand hygiene in health care

• Washing hand with soap & water

• Preferably use an alcohol based hand rub for routine hand antisepsis

• When alcohol based hand rub is already used do not used antimicrobial soap concomitantly.

Perform hand hygiene

• Before & after having direct contact with patients• Before handling an invasive device for patient care

regardless of whether or not gloves are used• After contact with body fluid or excretion , mucus

membrane, non intact skin, or wound dressing.• If moving from a contaminated body site to a clean

body site during patient care.• After contact with inanimate objects (including

medical equipment) in the immediate vicinity of the patient.

4) disinfection• Sterilization of instrument• Disinfection of article used by patient• Patients urine, faeces, sputum should be

properly disinfected

5) Dust control

• Suppression of dust by wet dusting & vacuum cleaning

6) Proper disposal of hospital waste

7) Control of droplet infection

• Face mask• Proper bed

lighting• ventilation

8) Nursing technique

• Barrier nursing

• Task nursing

9) Administrative measures

• There should be hospital control of infection committee

Hospital infection control committee

• Medical superintendent- chairperson• Representative from major clinical

departments.• Representative for nursing services.• CSSD in charge.• OT in charge.• Microbiologist.

Standard to be maintained in hospital

An attempt should be made to achieve and maintain an average

count of 10-15 bacteria/cubic foot of air in hospital

less than 5 bacteria/ cubic foot- minimal risk of infection

more than 35 bacteria/ cubic foot of air- heightened risk

Guideline to evaluate the floor cleaning procedure

Based on rodac plate count

• 0-25 bacteria/cubic foot- good floor cleaning procedure

• 26-50 bacteria/cubic foot- satisfactory• More than 50 bacteria/cubic foot- not

satisfactory

Role of central sterile supply department (CSSD)

• CSSD is an accepted feature of hospital planning.

Function of CSSD

• Supply of sterile instrument & material for dressing & procedure carried out in wards & department.

• Sterilization of instrument & linen for use in operation theatre

CSSD also look after

• Disinfection & sterilization of medical equipment such as ventilators, baby incubators, oxygen tents etc.

• Selection & distribution of single use (disposable) sterile supplies such as catheters, suction tubing & syringe.

CSSD of our hospital

• Manual steam sterilizer

• Semi-automatic steam sterilizer

Automatic steam sterilizer

ETO (ethylene trioxide) sterilizer

Washer disinfector

Ultrasonic cleaner

Gloves unit in CSSD

Glove washer

Glove dryer

Glove testing machine

Glove powdering machine

References• Park’s textbook of Preventive & social medicine• Harrisons principle of internal medicine• Textbook of microbiology: Ananthnarayana• Bennett & Brachmans hospital acquired infection:

William R. Jarvis• Hospital administration: Francis & De Souza• www.burnsjournal.com date 09-07-2012• www.ann-clinmicrob.com date 09-07-2012• www.jornalofhospitalinfection.com date 09-07-

2012• CSSD of UP RIMS&R Saifai, Etawah

THANK YOU