Download Nosocomial Infection

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