Download What are nosocomial (hospital acquired) infections?

Risks of hospitalization
Petra Sedlářová
Jana Heřmanová
Sentinel events
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http://www.youtube.com/watch?v=2kCG
IcFEB68&feature=related
What are nosocomial (hospital
acquired) infections?
All infections that the patient acquires
during hospitalization
 The patient did not have any signs of
the disease (obvious or latent) before
hospitalization, it is not related to the
admitting diagnosis
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The cost of nosocomial infections
Increase in morbidity and mortality
 Worsening of life quality
 Prolonged hospitalization
 Increase in health care costs
 Loss of life

Most common infection sites
Urinary tract
 Respiratory tract
 Bloodstream
 Wounds
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Contributing factors
Insufficient preventive measures
 Overuse of antibiotics
 Aging population
 Development of diagnostic and
treatment technologies
 Complicated surgical procedures
 Intensive care
 Oncology treatments
 Transplantations ...
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Patient’s factors
Immunodefficiency
 Invasive procedures
 Resistant bacteria
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The place of origin
Exogenous – hospital environment or
personnel
 Endogenous – the patient himself
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– Normal flora that becomes aggressive in
case of immunity impairment
– Escherichia coli, Staphylococcus aureus,
enterococci
Prevention of endogenous infections
Proper antibiotic therapy, based on
culture results
 Immunostimulation therapy
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Prevention of exogenous infections
Obeying hygiene and epidemiologic
guidelines
 Barrier nursing care
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Prevention can decrease the occurrence
of the infections by 1/3
Reporting infections
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It is obligatory – the hospital
epidemiologist
What to do during admission
Thorough medical history
 If the infection cannot be ruled out the
patient is admitted to the observation
room + further examinations
 When the infection is confirmed the
patient is put in isolation or admitted to
infectious diseases department
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Barrier nursing
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Protects the patients as well as the staff
Handwashing
 Cleaning, disinfecting and sterilizing
 Using protective equipment
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– gloves
– uniform (washed in the hospital laundry)
– lab coats, drapes, face shields, goggles, caps
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Bed linen
– Place into proper containers
– Do not mix with clean linen (the storage and
transport)
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Body fluids, used instruments, other
material
– Prevent contamination of outer surfaces of
lab tubes
– Use safe equipment (eliminate injuries)
– Sharps and needles into special containers
– Red bag for infectious waste
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Do not cause infectious aerosol and
dust
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Individual equipment for patients
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Isolate infectious patients or patients at
risk
Thorough sterilization of used
instruments, equipment, material
 Disinfection of the environment
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Specific measures in preventing
respiratory infections
Prevent aspiration of contaminated
material
 Change ventilation systems and
nebulizers every 24 – 48 hours
 Use sterile water into nebulizers
 Use disposable or separate inhalers for
patients, dry thoroughly after cleaning
 Aseptic suctioning technique
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Prevention of UTI
Keep urinary catheterization to a
minimum
 Proper insertion and care of indwelling
catheter
 Good perineal care
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Prevention of infections related
to intravascular cannulas and
catheters
Aseptic insertion technique
 Proper insertion site care
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– Dressing
– Changing insertion sites every 2 – 3 days
– Tubing changes
– Strict aseptic procedure when handling
central venous catheters
Prevention of wound infections
Good operative technique, wound
debridement, aseptic techniques during
dressing changes, personnel with active
infection will not take care of patients in
surgery
 Antibiotic prophylaxis
 Antibiotic therapy
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Cleaning and disinfection
Standard units –1x daily
 OR – at the beginning of shift and after
each client
 ICU, labs - 3x daily
 Following disinfection guidelines
 Painting and „big cleaning“ – 1-2x yearly
or more often when needed
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Waste disposal
All waste removed from unit daily
 Remove waste immediately from
patient’s bedside
 Mark waste that can cause injuries –
hard, locked containers that can be
disposed of in furnace
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What about the staff?
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It is obligatory to report infectious
disease in family
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Dress code
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Use gloves any time there may be
contact with body fluids
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Before cleaning equipment
decontaminate it with anti-viral agent
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Personal hygiene guidelines
Disinfecting
Disinfectants and antiseptics are
chemical solutions with bactericidal or
bacteriostatic properties
 Disinfectant is used on inanimate
objects
 Antiseptics are used on skin or tissue
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Disinfections protocols
Use proper disinfectant (targeting)
 Consider recommended concentration
and time of exposure
 Remove soap first, some disinfectants
are ineffective with soap
 Remove organic material (blood, saliva,
sputum, pus, excretions)
 Treat all surfaces and areas
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Sterilization
Destroys all organisms including spores
and viruses
 Common methods:
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– Heat
– Gas
– Boiling water
– Radiation
Moist heat
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Steam under pressure (autoclaves, 121
- 123ºC, pressure 15 to 17 pounds
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Free steam 100ºC (when autoclave would
destroy objects)
Gas
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Ethylene oxide gas interferes with
metabolic processes of microorganisms,
effective against spores
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Can be used for heat-sensitive items
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It is toxic to humans
Boiling water
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Practical and inexpensive in the home
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Does not kill viruses and spores
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Boil for minimum of 15 minutes
Radiation
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Ionizing and nonionizing (ultraviolet
light)
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Ionizing is used to sterilize food, drugs
and other items sensitive to heat
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It can be very expensive
Isolation precautions (CDC and
prevention)
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Measures designed to prevent spread of
microorganisms to patients, personnel and
visitors
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Several types of precautions
–
–
–
–
–
–
Category specific
Disease specific
Universal
Body substance isolation
Standard
Transmission based
Universal precautions (1987)
Used with all patients
 Targeted to blood/borne pathogens
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– Hepatitis B, C
– HIV
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Used in conjunction with other
precautions
Category specific
Strict isolation
 Contact isolation
 Respiratory isolation
 Tuberculosis isolation
 Enteric precautions
 Drainage/secretions precautions
 Blood/body fluid precautions
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Disease specific
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Specially equipped rooms
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Sharing rooms with patients with same
pathogens
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Wearing gowns by personnel
Body substance isolation (1993)
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For all clients except those with diseases
spread through the air
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Based on three premises:
– All people have an increased risk for infection
placed on their mucous membranes and nonintact
skin
– All people are likely to have potentially infectious
microorganisms in their moist body sites and
substances
– An unknown number of clients and staff will be
always colonized or infected
Standard precautions (1996)
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Used with all hospitalized patients
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Apply to blood, all body fluids,
secretions, excretions except sweat,
non/intact skin, mucous membranes
Transmission based precautions
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Airborne precautions – droplets <5 microns
(measles, varicella, tuberculosis)
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Droplet precautions – droplets >5 microns
(diphteria, pertussis, mumps, rubella,
streptococcal pharyngitis, pneumonia, scarlet
fever in infants and young children)
…transmission based
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Contact precautions – transmission by direct
client contact or by contact with items in the
client’s environment
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GI, respiratory, skin, wound infections or
colonization with multidrug-resistant bacteria
(Clostridium difficile, enterohemorrhagic
E.coli, Shigela, hepatitis A, respiratory
syncytial virus, parainfluenza virus, scabies,
herpes simplex, impetigo etc.), VRE, MRSA
Risk for fall
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MUfU6Ps
 Causes, assessment, prevention
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