Download HOSPITAL ACQUIRED (NOSOCOMIAL) INFECTION

HOSPITAL ACQUIRED
(NOSOCOMIAL)
INFECTION
jschangco,icn 2003
DEFINITION:
ANY INFECTION ACQUIRED BY A
PATIENT IN HOSPITAL.
SOME STATISTICS:
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Affects approx. 10% of all in-patients
(KFHUrate the last 5 years 1.14%)
delays discharge
HAI costs 2times >no infection
direct cause deaths
Socio-economic burden of HAI
SOURCES:
1.Patients own flora - Endogenous (50%)
Auto-Infection
( Greatest source of potential danger)
2.Environment - Exogenous(15%)
(Air-5%; Instruments-10%)
3.Another Patient/Staff - Cross Infection (35%)
Classification of surgical procedures
Clean
no entry into GI/GU/Resp tract
low risk
infection usually exogenous
Clean contaminated
no significant spillage
e.g. cholecystectomy
infection rates 5-10 %
Contaminated
Significant spillage of bacteria expected Infection rate 18-20%
Dirty
Perforated viscus drainage of
abscess Infection rate often >30%
IMPORTANT CROSS-INFECTION
ORGANISMS
METHICILLIN RESISTANT STAPH
AUREUS (MRSA)
Resistant to Flucoxacillin and usually others
May cause Wound infection
Bacteraemia
Skin/soft tissue infection
U.T.I.
Pneumonia etc.
Colonisation common:
Nose Axilla Perineum
Wounds/Lesions
Spread By:
Hands
Fomites
Aerosols
Becoming more common in the Community
Control:
Eradication of carriage
Barrier nursing
Screening of other patients Staff
TUBERCULOSIS
Open pulmonary TB (Sputum smear positive for
AFB)
VIRAL INFECTIONS
Chicken Pox
(Hepatitis B HIV)
RESISTANT GRAM NEGATIVE
ORGANISMS
Resistance to multiple antibiotics
Organisms:
E .coli
Proteus
Enterobacter
Acinetobacter
Pseudomonas aeruginosa
Cause:
Bacteraemia
U.T.I.
Pneumonia
Wound infection
Control:
Antibiotic Policy
Control of Infection Guidelines
Prevention of Cross Infection especially on high risk
areas
SURVEILLANCE
Important means of monitoring HAI
Early detection of trends outbreaks
1. Laboratory Based
Microbiology Laboratory lists +ve organisms
ICN reviews ‘Alert organisms’ reported
2. Ward Based
Ward staff monitor patients
ICN reviews ICN visits wards
H.A.I. IS INCREASING:
 compromised patients
 ward and inter-hospital transfers
 antibiotic resistance (MRSA, resistant Gram
negatives)
 increasing workload
 staff pressures
 lack of facilities
 ? lack of concern
HAI is inevitable but some is preventable
(irreducible minimum)
 realistically reducible by 10-30%
Many Personnel Don’t Realize
When
They Have Germs on Their Hands
• Healthcare workers can get 100s to 1000s of
bacteria on their hands by doing simple tasks
like:
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pulling patients up in bed
taking a blood pressure or pulse
touching a patient’s hand
rolling patients over in bed
touching the patient’s gown or bed sheets
touching equipment like bedside rails, overbed
tables, IV pumps
Casewell MW et al. Br Med J 1977;2:1315
Ojajarvi J J Hyg 1980;85:193
GENERAL PRINCIPLES
Good general ward hygiene:
- No overcrowding
- Good ventilation
- Regular removal of dust
- Wound dressing early in day
- Disposable equipment
 HAND WASHING
most important Before and after patient contact
before invasive procedures
Why
Don’t Staff Wash
their Hands
(Compliance estimated at less than 50%)
Why Not?
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Skin irritation
Inaccessible hand washing facilities
Wearing gloves
Too busy
Lack of appropriate staff
Being a physician
(“Improving Compliance with Hand Hygiene in Hospitals” Didier Pittet. Infection
Control and Hospital Epidemiology. Vol. 21 No. 6 Page 381)
Why Not?
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Working in high-risk areas
Lack of hand hygiene promotion
Lack of role model
Lack of institutional priority
Lack of sanction of non-compliers
Successful Promotion 
• Education
• Routine observation & feedback
• Engineering controls
– Location of hand basins
– Possible, easy & convenient
– Alcohol-based hand rubs available
• Patient education
(Improving Compliance with Hand Hygiene in Hospitals. Didier Pittet. Infection Control and
Hospital Epidemiology. Vol. 21 No. 6 Page 381)
Successful Promotion 
• Reminders in the workplace
• Promote and facilitate skin care
• Avoid understaffing and excessive
workload; Nursing shortages have caused
Hand Hygiene
Easy, timely access to both hand hygiene
and skin protection is necessary for
satisfactory hand hygiene.
A study by Pittet showed a 20% increase in
compliance by using feedback and
encouraging the use of alcohol hand rubs
Hand Hygiene Techniques
1. Alcohol hand rub
2. Routine hand wash 10-15 seconds
3. Aseptic procedures 1 minute
4. Surgical wash 3-5 minutes
Routine Hand Wash
Repeat procedures until hands are clean
Alcohol Hand Rubs
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Require less time
Can be strategically placed
Readily accessible
Multiple sites
All patient care areas
Alcohol Hand Rubs
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Acts faster
Excellent bactericidal activity
Less irritating (??)
Sustained improvement
Alcohol Hand Rubs
Choose agent carefully:
– Adequate antimicrobial efficacy
– Compatibility with other hand
hygiene products
Visible soiling
Hands that are visibly soiled or
potentially grossly contaminated
with dirt or organic material
MUST by washed with liquid
soap and water
Areas Most Frequently Missed
HAHS © 1999
Hand Care
• Nails
• Rings
• Hand creams
• Cuts & abrasions
• “Chapping”
• Skin Problems
Hand hygiene is the
simplest, most effective
measure for preventing
hospital-acquired
infections.
PREVENTING CROSS INFECTION
If known or suspected on admission to hospital, or
detected following admission:
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Isolation (barrier precautions)
Inform Infection Control team
Treatment - if appropriate
Regular surveillance
Any Questions???
• Thank you for not asking!!!
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