Practical methods to control hospital acquired

infections

presented by : Faiqa ali chughtai

Case 1:

• 1 yr old male child• Presented with fever, respiratory distress and

stidor• Intubation was performed and

dexamethasone was administered• After two days , child presented with signs and

symptoms of aspiration pneumonia

Case 2:

• A 5 months old male child • presented with a.w.d , severe dehydration &

acute kidney dysfunction• Rehydration • For Kidney function monitoring urinary

catheter was inserted• With in 36 hrs diarrhea was resolved, but

patient showed signs of infection

Case 3 :• 5 years old female presented to hospital with fever ,

respiratory distress• 1st diagnosed as T.B pt , latter ruled out, ceftriaxone was

prescribed and held latter diagnosed with pneumonia• Benzyl penicillin & co amoxicalve were prescribed• No improvement was found after 3 days ciprofloxacin

was prescribed but in sub therapeutic dose, • Latter effusion n consolidation was diagnosed • and vancomycin ,tanzo and clarithromycin were added

to regimen• after 20 days the microbe was found resistant to

quinolones, aminoglycocides, microlides , beta lactam antibiotics. Only vancomycin was effective

Point to ponder !

• Similarity between these cases:• All were by inflicted by

infections after admission to hospital

Conditions in our hospital

NOSOCOMIAL INFECTIONS

• Hospital acquired infections / nosocomial infections.

• The term "nosocomial" comes from two Greek words:

• "nosus" meaning "disease" + "komeion" meaning "to take care of.“

• Hence, "nosocomial" should apply to any disease contracted by a patient while under medical care .

Definition

According to WHO• An infection acquired in 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 .

Commonly occurring nosocomial infection

Who is responsible for noscocomial infections?

1 •Patient –for visiting hospital•for weak immunity

2 •Doctor-for prescribing antibiotics•For invasive procedures

3 •nurses-for not using aseptic procedures

4 •Hospital cleaners-for not being glued to mop & phenyl

5 •Microbes-for being there in 1st place

Where is pharmacist in this chain?May be we are too busy in avoiding the blame

Factors effecting nosocomial infections

Patient susceptibility • Endogenous

infections• immunity• Normal flora• Malnutrition

Iatrogenic • Treatment &

intervention related

• Anti microbial resistance

• Involvement of pharmacist

Microbial agents & organizational • Cross

contaminations• Facilities• hygiene• Microbial flora

of unit • Vectors of

microbes• overcrowding

Known nosocomial infections

• Ventilator-associated pneumonia• Staphylococcus aureus• Methicillin resistant Staphylococcus aureus• Candida albicans• Pseudomonas aeruginosa• Acinetobacter baumannii• Stenotrophomonas maltophilia• Clostridium difficile• Tuberculosis• Urinary tract infection• Hospital-acquired pneumonia• Gastroenteritis• Vancomycin-resistant Enterococcus• Legionnaires' disease

Strategy for control1 •Take care of already present

infections

2 •Control iatrogenic factors & AMR

3 •Establish infection control committee

4 •Define roles

5 •Role of pharmacist

6 •Surveillance & policies

7 •Training & education

8 •Cleanliness & hygiene

9 •Control airborne , waterborne , infections

10 •Control vector of infection

Infection control committee

• Involving management, physicians, other health care workers, clinical microbiology, pharmacy, central supply, maintenance, housekeeping, training services

• must report directly to either administration or the medical staff to promote program visibility and effectiveness.

Review & approve surveillance policy

Identify areas of intervention

Promote healthy pactice

ensure appropriate staff training

review risks associated with new devices & treatment

Provide input into investigation

of epidemics

Promote co-operation between health care providers and committees working in hospital

Management • education and

training • reviewing the

nosocomial infections

• Ensure authority of infection control team

Physician & nurses• Comply with

infection control policies

• Use aseptic techniques

• Take proper med for infections they have

Pharmacist • Promoting

pharmaceutical preparations that prevent

• transmission of infectious agents

• Maintain relevant record of antimicrobials

• Maintain appropriate storage

ROLE OF PHYSICIAN, MICROBIOLOGIST & PHARMACIST IN Control of AMR

• Combine microbial sampling+biomarkers+diagnosis+treatment

• Go for early diagnosis, early therapy within 48-72 hrs

• Avoid longer stay at hospital• Go for de-escalation policy• Selective on basis of microbe• Decrease dose in acc. With infection condition• monotherapy

Control of nosocomial infections• 1st: treat present infections:• Treatment for resistant microbes

Hospital acquired infection

•Ceftriaxone•Imipenum

Ampicillin resistant

•Ampi+salbactum

MRSA •vancomycin

VRE enterococci

•Linezolid,tigecycline

Do surveillance Make list of a.bPrescribe

acc.to narrow spectrum

Use prophylactic a.b if proved

valuable

•Perform antibiotic susceptibility test and monitor the trends in prevalence of bacterial resistance to antimicrobial agent. •Make list ,prescribe according to that.•Tailor list according to institutional microbial flora

Pharmaceutical preparations

• obtain• Store • distribute

Maintain record

•Potency•Incompatibility•Storage conditions•Deterioration conditions

Summary reports

•Provide reports to •Antimicrobial use committee•Infection control committee

Role of pharmacist

Info

on

antimicrobials

Properties:Concentration, TemperatureLength of actionSpectrumToxic propertiesIncompatibilitiesHarmful effects

Disinfection

Develop guidelines and productsMonitor Q.C of sterilization procedures

Therapy dev

elop

ment

Develop institution tailored therapy

Role of pharmacist

ROLE OF NURSES & PHYSICIANS

– Use of aseptic techniques while administering parental

– Use of gloves, and hand washing practice– Use of no touch technique , as far as possible.– Keeping check of i/v & catheter inflicted infections– Ensure that housekeeping is performing its

functions properly

DEVELOPMENT OF PERFORMANCE MANUALS

• Infection control committee must develop manuals for , food providing services , housekeeping services , laundry services, hospital hygiene services

• Organize surveillance program for nosocomial infections

• Involve pharmacy in development of supervision program for use of anti infective drugs

Education & training

• Organize teaching programs for medical , nursing , allied health personnel

• Arrange courses for awareness of pharmacist so that they may supervise nursing staff for

proper dispensing of medicines • Provide expert advice , analysis & leadership in

outbreak investigation & control• Undertake research in hospital hygiene &

infections

• Rates OF infection are obtained by dividing a numerator (number of infections or infected patients observed) by a denominator (population at risk, or number of patient-days of risk). The frequency of infection can be estimated by prevalence and incidence indicators

PHASES of nosocomial infections control

• Surveillance • Policy development

1st phase

Arrest of Modes of transmission

Contact transmission

• Droplet transmission

Airborne transmission

• Common vehicle transmission

Vector borne transmission

Methods to control modes of transmission

• Reducing person-to-person transmission• Hand decontamination• Safe injection administration• Preventing transmission from the

environment

UTI

SURGICAL SITE INFECTION

PNEUMONIA

VASCULAR DIVICE INFECTION

MEASURES FOR CONTROL OF

NOSOCOMIAL INFECTIONS

Guidelines for physicians, nurse & pharmacist

• Wash hands promptly after contact with infective material

• Use no touch technique wherever possible• Wear gloves when in contact with blood, body

fluids, secretions, excretions, mucous membranes

and contaminated items• Wash hands immediately after removing gloves• All sharps should be handled with extreme care

Guidelines • Clean up spills of infective material promptly• Ensure that patient-care equipment, supplies

and linen contaminated with infective material is either discarded, or disinfected or sterilized between each patient use

• Ensure appropriate waste handling• If no washing machine is available for linen

soiled with infective material, the linen can be boiled.

Cleaning of the hospital environment

• Zone a-no pt –normal domestic cleaning• Zone b-pt –non infected-not highly susceptible-

no dry cleaning, use of detergent solutions• Zone c-infected pts-disinfectant/detergent

solution, separate cleaning equipment for each unit

• Zone d-highly susceptible pts-protected/ isolated-disinfectant/detergent solution, separate cleaning equipment for each unit

Sterilization & disinfection

• Use of hot/superheated water• Disinfection with hot water• 1. Sanitary 80 °C 45–60 seconds equipment• 2. Cooking 80 °C 1 minute utensils• 3. Linen 70 °C 25 minutes 95 °C 10 minutes

Waterborne infections

• Gram-negative bacteria:• Pseudomonas aeruginosa• Aeromonas hydrophilia• Burkholderia cepacia• Stenotrophomonas maltophilia• Serratia marcescens• Flavobacterium meningosepticum

Water born infections

• Acinetobacter calcoaceticus• Legionella pneumophila and other• Mycobacteria:• Mycobacterium xenopi• Mycobacterium chelonae• Mycobacterium avium-intracellularae

Microbiological monitoring• Regulations for water analysis (at the national level

for drinking-water, in the Pharmacopoeia for pharmaceutical waters) define criteria, levels of impurities, and techniques for monitoring.

• Methods used for monitoring must suit the use.• Infections attributable to water are usually due to

failure to meet water quality standards for the specific use.

• Infection control/hygiene teams must have written, valid policies for water quality to minimize risk of adverse outcomes attributable to water in health care

settings.

Airborne infections

• Depend on :• 1.Type of infections• 2. Quality of air provided• 3. Rate of air exchange• 4. Number of persons present in wards• 5. Movement of personnel• 6. Level of compliance with infection control practices• 7. Quality of staff clothing• 8. Quality of cleaning process

Control of airborne infections

• Appropriate ventilation is necessary, and must be monitored within risk areas, e.g. orthopedics, vascular surgery and neurosurgery.

• Unidirectional airflow systems should be incorporated in appropriate areas in new hospital construction

Control of vectors

• Arthropods :• Cockroaches are source of Streptococcus species• Bacillus species (except Bacillus subtilis) • Bacillus subtilis• Staphylococcus aureus• Staphylococcus epidermidis• Enterococcus species• Corynebacterium species

control of cockroaches

• The keys to controlling cockroaches are sanitation and exclusion: cockroaches are likely to reinvade as long as a habitat is suitable to them (i.e., food, water, and shelter are available)

• Sprays can be used to suppress the population

sterilization

Precautionary measures to avoid infections

• traffic flow to minimize exposure of high-risk patients and facilitate patient transport

• adequate spatial separation of patients• adequate number and type of isolation rooms• appropriate access to hand washing facilities• appropriate ventilation for isolation rooms

and special patient care areas (operating theatres,transplant units)

• preventing patient exposure to fungal spores with renovations

Final solutionCO-ORDINATION & CO-OPERATION

physician

microbiologist

Cleaning & housekeeping

dptnurses

pharmacist