Download Nosocomial Infections and Infection Control

Hani Masaadeh, MD, Ph.D
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Healthcare epidemiology: Any activity that
Improve patient care outcomes.
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Epidemiology, laboratory investigation,
surveillance, device and procedure
management, education and information.
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Standardized procedures.
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Hospital acquired infections.
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Community acquired infections.
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14 days of hospital discharge.
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Iatrogenic infections.
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Infectious diseases (infections) can be divided
into two categories depending on where the
person became infected: (a) infections that
are acquired within hospitals or other
healthcare facilities (called healthcareassociated infections or HAIs)a and (b)
infections that are acquired outside of
healthcare facilities (called communityacquired infections).
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Community-acquired infections are those
that are present or incubating at the time of
hospital admission.
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All other infections are considered HAIs,
including those that erupt within 14 days of
hospital discharge.
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Over all around 5% of those admitted.
Added $4.5 billion to healthcare.
Things are much better now than before.
Pathogens:
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Patients, healthcare professionals, visitors.
Sinks, mobs, showerheads, flower pots.
G+ cocci, G-ve bacilli, patients, environment.
Resistant bacteria stays.
MDRTB, VRE, MRSA, MRSE, HIV, Candida spp. protozoa
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UTI (32%, 13%)
Surgical Site Infections (22%, 8%)
Lower Respiratory Tract Infections (15%,
36%)
Blood stream infections, (15%, 31%)
Clostridium difficile and AAD, PMC
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Immunosuppressed patients:
 Age, aggressive medical or surgical interventions,
prosthetic devices, organ transplantation.
 Women in labor or delivery, premature infants,
diabetes and cancer pts, Steroids and
chemotheraputic agents, and radiotherapy,
immunosuppressed pts, renal dialasis or caths.
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Increase drug resistant pathogens.
Failure of healthcare professionals to follow infection control
guidelines.
Increase # of immunocompromised pts.
Antibiotics abuse.
False sense of security about antibiotics → neglect of aseptic
techniques.
Lengthy and more complicated surgery.
Pts overcrowding and shortage of staff.
Untrained healthcare professionals.
Use of many immunosuppressed procedures.
Over use of indwelling medical devices.
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Strict compliance with infection control
guidelines.
Hands washing, Before and After.
Sterilization and disinfection techniques.
Filtration, UV light, isolation, gloves, masks,
gowns whenever appropriate.
Break the chain of infection.
Ignas semmelweis and Josef Lister.
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Medical:
 Prevent direct or indirect method of transmission.
 Frequent and thorough handwashing.
 Disinfection.
 Proper disposal of needles.
 Contaminated material and waste.
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Surgical Asepsis:
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Keep objects and areas sterile.
Medical vs surgical.
Hospital areas and invasive procedures.
Scrubing.
Patient preparation.
Instruments.
Sharp items disposal.
Floors and ventilation.
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Prevent transmission of pathogens.
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All of hospitalized patients.
Blood borne and moist body substance.
Guidelines for handwashing.
Gloves, masks, eye protection, gowns, soiled
linen, needles disposal, sharp objects disposal.
 Resuscitation devices.
 Protect healthcare frofessionals from HIV and
HBV.
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The single most important procedure.
Before and after patient contact.
Between tasks for the same patient.
After contamination with infected material.
Even after wearing gloves.
After gloves removal.
Regular or antiseptic soap.
Use fricion, circular motion.
Paper towels or dry air.
Alcohol swabs.
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Healthcare workers must clean hands
BEFORE and AFTER every patient
contact.
Alcohol – based hand gels / foam may be
used as a substitute for when soap and
water are not available.
Gels / foam CANNOT be used
 if hands are visibly soiled or
 the patient is on isolation for Clostridium
difficile diarrhea (not effective on spores).
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Blood.
Body fluids.
Secretions.
Excretions.
Mucus membranes.
Nonintact skin.
Change between tasks.
Wash hands after removal of gloves.
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Splashes or sprays of blood or body fluids.
Masks protects from large droplets.
Gowns protects against splashes.
Remove as soon as possible.
Wash hands immediately.
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Can,t be reused unless properly cleaned,
disinfected or sterilized.
Dispose single use items.
Bag visibly contaminated articles.
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Comply with adequate procedures.
Routine care.
Cleaning disinfecting surfaces.
Beds and bedrails.
Bedside equipment.
Other frequently touched surfaces.
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Usually contaminated with blood, body
fluids, excretions, secretions.
Handle, transport and process carefully.
Prevent contamination to yourself or to
others.
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Needlestick injuries.
Broken glass and other sharps.
HIV, and HBV.
Standard precautions.
Safty procedures.
Never resheath used needles using both hands,
use one-handed scoop technique.
 Mechanical devices for needle disposale.
 Never remove needle by hand or break needles.
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An accidental injury by a sharp object contaminated with infectious
material. Sharps include:
 Needles
- Scalpels
 Broken glass
- Exposed ends of dental wires
 Anything that can pierce, puncture or cut your skin.
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Blood or body fluid contamination of
 open cuts, nicks and skin abrasions
 dermatitis and acne
 mucous membranes of your mouth, eyes or nose.
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Indirect transmission, such as touching a contaminated object or surface
and transferring the infectious material to your eyes, nose or open skin.
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Follow hospital Infection Control and
Safety policies.
The use of Universal Precautions and
safety devices will decrease the incidence
of occupational exposures.
Universal Precautions consist of
 appropriate workplace practices
 engineering (safety) controls, and
 using Personal Protective Equipment (PPE).
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Hepatitis B is a serious liver infection caused
by a specific virus, HBV.
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Hepatitis C is a viral infection of the liver. It
was formerly called non-A non-B hepatitis. It
is both an acute infection and, if the infection
continues for more than six months (as it
does in most), a chronic hepatitis.
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The human immunodeficiency virus attacks
the body's immune system, causing the
disease known as AIDS, or Acquired Immune
Deficiency Syndrome.
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Soon after infection, the person may suffer from flu-like symptoms,
fever, diarrhea and fatigue.
A person infected with HIV may then carry the virus without developing
further symptoms for several years.
Ultimately, a person infected with HIV will almost certainly develop AIDS,
at which time they may also develop AIDS-related illnesses.
These include neurological problems, cancer, and opportunistic
infections such as severe pneumonia, brain abscesses and infectious
diarrhea.
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Use private rooms for patients who
contaminate the hospital environment.
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Those who cann,t assist in providing proper
hygiene or environmental control.
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Hospital transmission by Airborne, Droplets, and
Contact → Precautions in addition to standard
precautions.
 Airborne precautions:
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 Droplets or dust.
 TB, Rubella, and Varicell virus.
 Private room, negative pressure, HEPA filters.
 Can be placed with other pt with the same disease.
 Respiratory masks.
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A form of contact transmission.
Coughing, sneezing, and talking.
Suctioning and bronchoscopy.
Meningococci, MDR pneumococci, and influenzae.
Standard precaution + private room.
Can share room with another pt with the same
pathogen.’
 No need for air ventilation filtration.
 Masks if within 3 feet from the patient.
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Most important and frequent.
Direct contact transmission
 MRD bacteria, Cl. Difficile, RSV, Scabies,
impetigo, chickenpox, viral hemorragic fevers.
 Private room beside the standard precautions.
 Wear gloves and change them immediately
before leaving the room, wash hands.
 Gown.
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Indirect contact transmission.
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TB is an infectious disease caused by the bacterium
Mycobacterium tuberculosis.
Pulmonary and laryngeal TB are usually spread from person to
person through contaminated droplet nuclei in the air.
Extrapulmonary TB is generally not contagious.
Infectious particles are released when people with pulmonary /
laryngeal TB cough, sneeze or talk.
Droplet nuclei are very small (1-5 microns in diameter) and stay
suspended in the air for long periods of time.
If these bacteria are inhaled, infection can occur.
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Patients or visitors with a "cough" should be
encouraged to cover their cough.
Tissues should be made available as needed.
Employees should wear a fitted N95
respirator if patients have
 a productive cough
 bloody sputum, or
 are suspected of having active TB.
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TB as an example.
Negative pressure rooms.
HEPA filters.
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Severely immunosupressed patients.
Burns, leukemias, radiation treatment and
leukopenic patients.
Reverse isolation.
Total protective environment (TPE).
Private positive pressure room + HEPA.
Sterile gowns, masks, gloves, caps, and shoe covers.
Handwashing.
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High quality fresh food.
Refrigeration.
Washing, preparing, and cooking, dispose if not eaten.
Proper hands washing before eating and after using the rest
room.
 Nasal and oral secretions disposal and washing hands after.
 Hair cover and wearing clean clothes and aprons.
 Periodic check for food handlers.
 Preventing with respiratory or GI disease from handling food
or eating utensils.
 Cutting boards clean, wash cooking and eating utensils.
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Any nonliving or inanimate object other than food.
Patients gowns, bedding, towels, eating and
drinking utensils, bedpans, stethoscopes, gloves,
thermometers, ECG electrodes.
Use disposables whenever possible.
Disinfect equipment after use.
One equipment for each pt.
Single time use equipment or clean properly.
Bed pans emptying and washing.
Linen and soiled clothing in bags → laundry.
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No leakage and proper sanitary condition.
All waste should be removed ASAP.
Address potential infectious items.
Sharps disposal.
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Infection control program is under the control
of infection control committee.
Representatives of the different departments
of the hospital.
Review the incidence of HAI infections in the
hospital.
Policy-making and review, pt and
environment surveillance, outbreak
investigation, education and reporting.
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Monitoring types and numbers of pathogens
isolated from hospitalized pts.
Notifying the appropriate ICP about unusual
# or type to investigate.
Processing environmental and employees
samples to pin point the source of pathogen.
Biotype and antibiogram or molecular
epidemiology.
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How are Blood-borne Pathogens
Transmitted?
Blood-borne pathogens are transmitted primarily through blood and semen,
although all body fluids and tissues should be regarded as potentially
infectious.
 The most common modes of transmission are
 sexual contact,
 needle sharing, and
 to a much lesser degree, infusion of contaminated blood products.
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An infected woman can pass pathogens to her fetus.
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These organisms are not transmitted by
 casual contact
 touching or shaking hands
 eating food prepared by an infected person
 from drinking fountains, telephones, toilets, or other surfaces.
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Follow hospital Infection Control and
Safety policies.
The use of Universal Precautions and
safety devices will decrease the incidence
of occupational exposures.
Universal Precautions consist of
 appropriate workplace practices
 engineering (safety) controls, and
 using Personal Protective Equipment (PPE).
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Clean affected area immediately.
Notify your supervisor immediately.
Complete an Incident/Accident form (to be
signed by supervisor).
Immediately report to Employee Health
Service, Mon. - Fri., 8 a.m.- 4 p.m.
All other times report to the Emergency
Department
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Hepatitis B is a serious liver infection caused
by a specific virus, HBV.
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HBV infection can range from mild to lifethreatening.
The most common symptoms are
 fatigue
 mild fever
 loss of appetite
 vague abdominal pain.
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Only a minority experience jaundice.
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Because more than two-thirds of all cases
have no symptoms, carriers are often not
aware of their HBV status.
Newer antiviral medications may allow many
patients to enjoy prolonged viral-suppression
periods.
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Hepatitis B has an incubation period of six
weeks to six months.
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Hepatitis C is a viral infection of the liver. It
was formerly called non-A non-B hepatitis. It
is both an acute infection and, if the infection
continues for more than six months (as it
does in most), a chronic hepatitis.
HCV infection can range from mild to life-threatening.
The most common symptoms are
 loss of appetite
 nausea and vomiting
 vague abdominal discomfort
 changes in stool and / or urine color.
 Chronic infection, if it occurs, may be symptomatic or
asymptomatic.
 Chronic hepatitis C is thought to eventually progress to
cirrhosis (severe liver disease) or liver cancer in up to 50% of
persons.
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HCV is spread through blood, blood products, body fluids, and at the
time of birth.
Persons at highest risk for infection include:
 users of intravenous drugs
 dialysis patients
 persons receiving unscreened blood or blood products
 health care workers frequently exposed to blood or blood products.
However, about half of all reported cases have no identifiable source of
infection
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Hepatitis C has an incubation period of two
weeks to six months, most commonly within
six to nine weeks.
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The human immunodeficiency virus attacks
the body's immune system, causing the
disease known as AIDS, or Acquired Immune
Deficiency Syndrome.
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Soon after infection, the person may suffer from flu-like symptoms,
fever, diarrhea and fatigue.
A person infected with HIV may then carry the virus without developing
further symptoms for several years.
Ultimately, a person infected with HIV will almost certainly develop AIDS,
at which time they may also develop AIDS-related illnesses.
These include neurological problems, cancer, and opportunistic
infections such as severe pneumonia, brain abscesses and infectious
diarrhea.
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For all occupational exposures, EHS will provide counseling,
monitor you for seroconversion and provide any necessary
follow-up.
There is no vaccine to prevent HIV infection.
Data published by the Centers for Disease Control and
Prevention (CDC) recommends post-exposure prophylaxis
with a combination of agents.
Recommendations from the CDC are frequently updated.
That is why it is imperative that exposed persons seek
treatment and evaluation immediately.
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High risk exposures include those that
 involve the blood of patients with far-advanced
AIDS
 sustain deeper needle-stick injuries
 there are larger amounts of blood present on the
exposing object.
TB is an infectious disease caused by the bacterium
Mycobacterium tuberculosis.
 Pulmonary and laryngeal TB are usually spread from person
to person through contaminated droplet nuclei in the air.
 Extrapulmonary TB is generally not contagious.
 Infectious particles are released when people with
pulmonary / laryngeal TB cough, sneeze or talk.
 Droplet nuclei are very small (1-5 microns in diameter) and
stay suspended in the air for long periods of time.
 If these bacteria are inhaled, infection can occur.
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Anyone can get TB but some are at higher risk for developing
active disease.
This includes
 elderly (have among the highest rates)
 HIV infected
 IV drug users
 people in close contact with infectious TB
 diabetics
 the chronically malnourished
 people from countries with high TB rates
 people with kidney failure
 people receiving cancer treatment
 employees or residents of long-term care facilities.
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TB usually affects the lung, but can occur at virtually any site
in the body, including the brain and spine.
The following symptoms indicate that a person could have
TB disease:
 chronic productive cough
 feeling tired all the time
 weakness
 night sweats
 unexplained weight loss
 anorexia (loss of appetite)
 fever
 hemoptysis (coughing up blood)
 cavitary lesions on chest x-ray, especially in the upper
lobes.