Download What are nosocomial (hospital acquired) infections?

yes no Was this document useful for you?
   Thank you for your participation!

* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project

Document related concepts

Schistosomiasis wikipedia , lookup

Dirofilaria immitis wikipedia , lookup

Clostridium difficile infection wikipedia , lookup

Pandemic wikipedia , lookup

Hepatitis C wikipedia , lookup

Human cytomegalovirus wikipedia , lookup

Hepatitis B wikipedia , lookup

Oesophagostomum wikipedia , lookup

Anaerobic infection wikipedia , lookup

Coccidioidomycosis wikipedia , lookup

Middle East respiratory syndrome wikipedia , lookup

Sexually transmitted infection wikipedia , lookup

Neonatal infection wikipedia , lookup

Carbapenem-resistant enterobacteriaceae wikipedia , lookup

Marburg virus disease wikipedia , lookup

Hospital-acquired infection wikipedia , lookup

Risks of hospitalization
Petra Sedlářová
Jana Heřmanová
Sentinel events
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
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
Contributing factors
Insufficient preventive measures
 Overuse of antibiotics
 Aging population
 Development of diagnostic and
treatment technologies
 Complicated surgical procedures
 Intensive care
 Oncology treatments
 Transplantations ...
Patient’s factors
 Invasive procedures
 Resistant bacteria
The place of origin
Exogenous – hospital environment or
 Endogenous – the patient himself
– Normal flora that becomes aggressive in
case of immunity impairment
– Escherichia coli, Staphylococcus aureus,
Prevention of endogenous infections
Proper antibiotic therapy, based on
culture results
 Immunostimulation therapy
Prevention of exogenous infections
Obeying hygiene and epidemiologic
 Barrier nursing care
Prevention can decrease the occurrence
of the infections by 1/3
Reporting infections
It is obligatory – the hospital
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
Barrier nursing
Protects the patients as well as the staff
 Cleaning, disinfecting and sterilizing
 Using protective equipment
– gloves
– uniform (washed in the hospital laundry)
– lab coats, drapes, face shields, goggles, caps
Bed linen
– Place into proper containers
– Do not mix with clean linen (the storage and
Body fluids, used instruments, other
– Prevent contamination of outer surfaces of
lab tubes
– Use safe equipment (eliminate injuries)
– Sharps and needles into special containers
– Red bag for infectious waste
Do not cause infectious aerosol and
Individual equipment for patients
Isolate infectious patients or patients at
Thorough sterilization of used
instruments, equipment, material
 Disinfection of the environment
Specific measures in preventing
respiratory infections
Prevent aspiration of contaminated
 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
Prevention of UTI
Keep urinary catheterization to a
 Proper insertion and care of indwelling
 Good perineal care
Prevention of infections related
to intravascular cannulas and
Aseptic insertion technique
 Proper insertion site care
– 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
 Antibiotic prophylaxis
 Antibiotic therapy
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
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
What about the staff?
It is obligatory to report infectious
disease in family
Dress code
Use gloves any time there may be
contact with body fluids
Before cleaning equipment
decontaminate it with anti-viral agent
Personal hygiene guidelines
Disinfectants and antiseptics are
chemical solutions with bactericidal or
bacteriostatic properties
 Disinfectant is used on inanimate
 Antiseptics are used on skin or tissue
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
Destroys all organisms including spores
and viruses
 Common methods:
– Heat
– Gas
– Boiling water
– Radiation
Moist heat
Steam under pressure (autoclaves, 121
- 123ºC, pressure 15 to 17 pounds
Free steam 100ºC (when autoclave would
destroy objects)
Ethylene oxide gas interferes with
metabolic processes of microorganisms,
effective against spores
Can be used for heat-sensitive items
It is toxic to humans
Boiling water
Practical and inexpensive in the home
Does not kill viruses and spores
Boil for minimum of 15 minutes
Ionizing and nonionizing (ultraviolet
Ionizing is used to sterilize food, drugs
and other items sensitive to heat
It can be very expensive
Isolation precautions (CDC and
Measures designed to prevent spread of
microorganisms to patients, personnel and
Several types of precautions
Category specific
Disease specific
Body substance isolation
Transmission based
Universal precautions (1987)
Used with all patients
 Targeted to blood/borne pathogens
– Hepatitis B, C
Used in conjunction with other
Category specific
Strict isolation
 Contact isolation
 Respiratory isolation
 Tuberculosis isolation
 Enteric precautions
 Drainage/secretions precautions
 Blood/body fluid precautions
Disease specific
Specially equipped rooms
Sharing rooms with patients with same
Wearing gowns by personnel
Body substance isolation (1993)
For all clients except those with diseases
spread through the air
Based on three premises:
– All people have an increased risk for infection
placed on their mucous membranes and nonintact
– All people are likely to have potentially infectious
microorganisms in their moist body sites and
– An unknown number of clients and staff will be
always colonized or infected
Standard precautions (1996)
Used with all hospitalized patients
Apply to blood, all body fluids,
secretions, excretions except sweat,
non/intact skin, mucous membranes
Transmission based precautions
Airborne precautions – droplets <5 microns
(measles, varicella, tuberculosis)
Droplet precautions – droplets >5 microns
(diphteria, pertussis, mumps, rubella,
streptococcal pharyngitis, pneumonia, scarlet
fever in infants and young children)
…transmission based
Contact precautions – transmission by direct
client contact or by contact with items in the
client’s environment
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
 Causes, assessment, prevention