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Nosocomial Infection ----Prevention and control Wang kefang(王克芳) [email protected] ScenarioⅠ Mrs. Helen is a 63-year-old woman with diabetes who underwent a total hip replacement. She did well after surgery, and her blood glucose levels are well controlled with medication and diet. On the afternoon of her seventh postoperative day, she complains to her nurse Kathy that she is having increased pain in her hip. Mrs. Helen also has a low-grade fever with a temperature of 37.7℃. Kathy observes the incision and notes that it is red, swollen, and warm. Kathy and a registered dietitian do a nutritional assessment on Mrs. Helen and find that she had a poor nutritional intake 1 month before her surgery because of hip pain and an inability to stand to prepare meals. Questions: 1. What kind of signs and symptoms indicated that there’re something wrong with Helen? 2 . How do you explain Mrs. Helen’s pain in her hip and fever? Nosocomial Infection ----Hospital Acquired Infection Broad concept Any infection or disease that any individual suffers from the invasion of pathogens in hospital. Narrow concept Any infection that patient suffers during their hospital care which was not present or incubating at the time of admission. This includes infections acquired in hospital but appearing after discharge, and also occupational infections among heath-care workers. ----卫生部《医院感染管理办法》2006 Concepts Classification Endogenous infection (autogenous infection) The causative microorganisms come from the clients’ themselves . Exogenous infection (cross infection) The causative microorganisms come from the other source than the clients’ themselves, such as:hospital personnel, other clients, and hospital environment. Scenario Ⅱ Mrs. Helen was diagnosed as surgical site infection. It is hospital acquired infection (HAI). Her doctor orders a wound culture for Etiological diagnosis and treatment. In addition, Mrs. Helen is receiving wound care, antibiotic therapy, and supportive care, including nutrition and progressive exercise. Questions: 1. Try to find the risk factors from the patient herself. 2. Where does the causative microorganisms come from? 3. How does the patient get the causative microorganisms? Chain of Infection Source of Infection Susceptible Host Chain of Infection Mode of Transmission Sources of Infection Human may have active infections Carrier may be in the asymptomatic and/or incubation period of an infectious disease, Endogenous patients’ normal flora Animal and Insect Health care setting patients, healthcare personnel, family members and other visitors Environment, equipment and apparatus Chain of Infection Modes of Transmission Contact Transmission Droplet Transmission Airborne Transmission Chain of infection Modes of Transmission Contact Transmission Direct contact Transmission transferred from one infected person to another person directly. Indirect contact Transmission the transfer of an infectious agent through a contaminated intermediate object or person. the contaminated hands of healthcare personnel are important contributors to indirect contact transmission Chain of infection Modes of Transmission Contact Transmission Droplet Transmission Respiratory droplets: Coughs, sneezes, talks, secretion suction, endotracheal intubation, and cardiopulmonary resuscitation Short distance <1m 猩红热、白喉、麻疹、流行性脑脊髓膜炎 Chain of infection Modes of Transmission Contact Transmission Droplet Transmission Airborne Transmission Fine particles/dust particles contain infective pathogens over time and distance Mycobacterium tuberculosis Chain of infection Susceptible hosts Factors affecting susceptibility include age, gender, race and heredity normal immune defenses underlying disease and medical therapy nutritional status social life mental health stress Chain of Infection Susceptible hosts younger children and older adults; severely impaired immune defenses; malnutrition; receiving various immune suppressed treatment; long-term use of antibiotics; receiving numerous invasive procedures; long operation time; extended length of hospitalization; not in good spirits, lack of active cooperation. Chain of Infection Chain of Infection Source of Infection Susceptible Host Chain of Infection Mode of Transmission Impact of nosocomial infection 宿州眼球事件 2005年12月11日,宿州市立医院眼科为10名患者做白内 障手术,至17日9名患者因感染实施单眼眼球摘除手术。 西安交大医院8名新生儿死亡 自2008年9月3日起新生儿科9名新生儿相继出现发热 、心率加快、肝脾肿大等临床症状,至9月15日8名新生 儿发生弥漫性血管内凝血相继死亡。 肌注部位分支杆菌感染暴发 1998年8月~11月某诊所59例病人发生肌注部位感染 山西煤炭中心医院血液透析感染事件 2008年12月至2009年1月,47名患者在太原公交公司 职工医院进行血液透析,20名患者丙肝抗体阳性。 SARS During the SARS pandemic, the proportion of infected health-care workers ranged from approximately 20% to 60% of cases worldwide. Impact of nosocomial infection More serious illness or deaths Prolong of stay in a health-care facility Long-term disability High additional financial burden:patients ,their families and society Infection control is very important for a hospital!!! 事件原因分析 宿州眼球事件 西 安 交 大 医 院 新 生儿感染 手术室布局、流程、环境、设施等不符合要求 手术器械的消毒和灭菌工作没有达到基本标准 术中微创手术器械不能做到一人一用一灭菌 新生儿科建筑布局和工作流程不合理 部分物品和器具采用了错误的消毒方法 医务人员没有规范地进行手卫生 肌 注 部 位 分 支 杆 菌感染暴发 山 西 煤 炭 中 心 医 院血液透析感染事 件 玻璃注射器15支 煮沸消毒,时间凭经验 注射重复使用换针头不换注射器 重复使用一次性血液透析 对丙肝抗体阳性患者无专机血液透析 使用工业用过氧乙酸对血液透析器进行消毒 Risks for Nosocomial Infection Immune defense decline Numerous invasive procedures Invasive devices are more important than underlying diseases in determining susceptibility to nosocomial infection Antibiotics abuse Physiologic factors Pathologic factors Psychological factors can cause resistant microorganisms to colonize in clients Ineffective management Health care workers who use poor aseptic or hand washing techniques Infection control 隔离 消毒灭菌 增强抵 抗力 WHO: Measures Technique: Aseptic Isolation Cleaning Disinfection Sterilization Infection control Correct use of antibiotics Surveillance of disinfection and sterilization efficacy 1 Basic Knowledge Concepts Classification Risk factors Chain of infection Measures for infection control