Post on 17-Jan-2023
NOSOCOMIAL INFECTIONS
Nosocomial comes from the Greek word
nosokomeion meaning hospital (nosos
= disease, komeo = to take care of). This
type of infection is also known as a
hospital-acquired infection (or more
generically healthcare-associated
infections
DR.T.V.RAO MD 2
WHAT ARE HOSPITAL ACQUIRED
INFECTIONS
An infection acquired in hospital by a patient
who was admitted for a reason other than that infection . An infection occurring in a patient in a hospital or other health care facility in whom the infection was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among
staff of the facility DR.T.V.RAO MD 3
Nosocomial infections are widespread. They are important contributors to morbidity and mortality. They will become even more important as a public health problem with increasing economic and human impact
NOSOCOMIAL INFECTIONS ON
PUBLIC HEALTH
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Increasing numbers and crowding of people. More frequent impaired immunity (age, illness, treatments). New microorganisms.
Increasing bacterial resistance to antibiotics contributed as emerging problem
CROWDING A MAJOR FACTOR
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WHEN THE NOSOCOMIAL
INFECTIONS MANIFEST
Majority of such infections
become evident during their stay
in the Hospital or some times only
after their discharge from the
patient.
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HOW AND WHEN HOSPITAL
ACQUIRED INFECTIONS OCCUR.
Nosocomial infections are infections which are a result of treatment in a hospital or a healthcare service unit, but secondary to the patient's original condition. Infections are considered Nosocomial if they first appear 48 hours or more after hospital admission or within 30 days after discharge.
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The patient is exposed
to a variety of
microorganisms
during hospitalization.
Contact between the
patient and a
microorganisms does
not by itself necessarily
result in the
development of clinical
disease — other factors
influence the nature
and frequency of
Nosocomial infections.
MICROORGANISMS AND
NOSOCOMIAL INFECTIONS
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Escherichia coli
Klebsiella,
Serratia,Proteus spp
Pseudomonas
aeruginosa
Enterococcus spp
Candida albicans
URINARY TRACT INFECTIONS
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RESPIRATORY INFECTIONS
Hemophilus influenzae
Streptococcus pneumonia
Staphylococcus aureus
Enterobacteriaceae
Respiratory viruses
Fungi, Candida spp
Aspergillus's spp
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SKIN SEPSIS AND WOUNDS
Staph aureus
Streptococcus pyogenes
E.Coli
Proteus spp
Anaerobic bacteria
Enterococcus spp
Coagulase negative
Staphylococcus
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GASTRO INTESTINAL INFECTIONS
Salmonella
serotypes
Clostridium
difficile
Norwalk like
viruses
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The likelihood of exposure leading to infection depends partly on the characteristics of the microorganisms, including resistance to antimicrobial agents, intrinsic virulence, and amount (inoculum) of infective material.
DRUG RESISTANCE – NOSOCOMIAL
INFECTION
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PATHOPHYSIOLOGY
Within hours of admission, colonies of
hospital strains of bacteria develop in the
patient's skin, respiratory tract, and
genitourinary tract. Risks factors for the
invasion of colonizing pathogens can be
categorized into 3 areas: iatrogenic,
organizational, and patient-related
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Iatrogenic risk factors include pathogens on the hands of medical personnel, invasive procedures (eg, incubation and extended ventilation, indwelling vascular lines, urine catheterization), and antibiotic use and prophylaxis.
IATROGENIC RISK
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ORGANIZATIONAL
Organizational risk
factors include
contaminated air-
conditioning systems,
contaminated water
systems, and staffing
and physical layout of
the facility (eg, nurse-
to-patient ratio, open
beds close together). DR.T.V.RAO MD 17
PATIENT ASSOCIATED
Patient risk factors
include the severity of
illness, underlying
immunocompromised
state, and length of
stay.
Prolonged stay in the
hospital is a Major
contributing factor
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A susceptible host and appropriate inoculum of infecting microorganism with an appropriate route of transmission contributed in majority of cases
ROUTES OF TRANSMISSION OF
INFECTION
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AIR – BORNE ROUTE From respiratory tract via
talking, coughing, sneezing
From the skin by natural shedding of the skin scales during would dressing or bed making.
From aerosols from equipment, respiratory apparatus, air-conditioning plants.
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In direct contact spread from person to person
By indirect contact spread via contaminated hands or equipment.
Clothing of staff,
Urinary catheters, contaminated with hands of the operator may introduce organisms, or patients own flora from urethra may contribute to infection
CONTACT SPREAD
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FOOD BORNE SPREAD
From hospital kitchen, or in special diets, infant feeds, kitchen, or commercial supplies
Mechanical vectors flies, cockroaches or insects, or rodents act as carriers of infection.
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The accidental
transmission of
infections as HIV,
HBV,and HCV by
needle stick injuries
is documented
Syphilis and malaria
a concern in high
prevalence areas
BLOOD BORNE SPREAD
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Lower bowel surgery,
Self infection may occur
due to flora from nose,
Staphylococcus may be
introduced into wounds.
Cross infection
between patients
occur due to spread
of Staphylococcus or
coli forms
SELF INFECTIONS AND CROSS
INFECTIONS
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OTHER CONTRIBUTING FACTORS
Surgeons punctured
surgical gloves, or
moistened gown,
imperfectly sterilized
surgical instruments, or
by airborne theatre
dust. Faulty wound
dressings may cause
infections.
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Self infection
from patient’s
own flora from
Bowel can be
major contributor
of infections in
bowel surgery.
PATIENTS OWN FLORA TOO INFECTIVE
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OTHER SOURCE OF HOSPITAL
INFECTIONS
Hospital environment, includes defective constructions,
People their behavior has great impact. Objects, food, water, Air in the hospital too contribute to infections.
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CROSS INFECTION
Many different bacteria,
viruses, fungi and
parasites may cause
Nosocomial infections.
Infections may be caused
by micro organism
acquired from another
person in the hospital
(cross-infection) or may
be caused by the patient’s
own flora (endogenous
infection).
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Some organisms
may be acquired
from an inanimate
object or
substances
recently
contaminated from
another human
source (environmental
infection).
USED/CONTAMINATED SYRINGES A
GREAT THREAT IN DEVELOPING WORLD
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CHANGING TRENDS IN INFECTION
ETIOLOGY
With advances in more elaborate surgery and
intensive care, with combined use of broad
spectrum antibiotics and immunosuppressive
drugs, Gram Negative bacteria increased in
importance
Pseudomonas aeruginosa gained importance
in causing infection in compromised patients.
They exhibit natural resistance to antibiotics
and antiseptics DR.T.V.RAO MD 30
EMERGING INFECTIOUS AGENTS
A group of Microbes
that played no role in
the past have emerged.
1 Coagulase negative
Staphylococci
2 Acinetobacter
baumanii
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MICROBES FROM ENVIRONMENT
The dissemination from environment such as cooling towers and hot water system is proving a threat with Legionella pneumophila causing infections of respiratory systems
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VIRUS TOO PLAY A IMPORTANT ROLE
Awareness on risk of
Blood born viruses
including
Hepatitis B, C and HIV
essential
CMV virus in association
with organ and cellular
transmission
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IATROGENIC SPREAD A CONCERN
The possible risk of
iatrogenic spread
of Prions causing
Creuzfeldt-Jacob
disease is a
concern
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COMMON SITES ASSOCIATED WITH
ETIOLOGICAL AGENTS
Urinary tract
Surgical wounds
Respiratory tract
Skin (especially burns)
Blood (bacteraemia)
Gastrointestinal tract
Central nervous system
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COLLECTION OF DATA IN CROSS
INFECTIONS
Always collect information and document information on
1 Patient details
2 Site and extent of infection
3 Date of admission – operative procedure
first recognition of infection
4 Specimen and laboratory isolates and
typing results
5 Ward and staff details.
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The basic responsibility of any good hospital remain with establishment of good infection control policies, which can always be achieved with
1 An infection control committee
· 2 An Infection team
PREVENTION AND CONTROL
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Should meet regularly to formulate and update policies for the whole hospital on all matter which have bearing on infection control and to mange outbreaks of Nosocomial infection
INFECTION CONTROL COMMITTEE
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INFECTION CONTROL TEAM
Which will function under the guidance of Infection control Doctor.
A Medically qualified Microbiologist, who will take responsibility of day to day for the policies formulated
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To do surveillance and infection monitoring of hygiene practices.
Educate the Medical and Paramedical staff on policies relating to prevention of infection, and safe procedures
THE FUNCTIONS OF THE COMMITTEE
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Is the key member of
the team
Maintain the close
working relations
between Microbiology
Laboratory, different
clinical services and
supportive services like
laundry, pharmacy and
engineering
INFECTION CONTROL NURSE
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ALL ARE CAMPAIGNERS OF SAFE
PRACTICES
It is the minimal
responsibility of the
members to
campaign on issues
related to safe
practices including
Hand washing
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Fundamental importance lies with supply of sterile instruments, dressings and fluids.
A availability of single use syringes, needles, catheters and drainage bags to be assured and planned for the regular supplies .
DECONTAMINATION AND STERILIZATION
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ASEPTIC TECHNIQUES A no touch technique when
dealing with sterile equipment
coupled with strict personal
hygiene.
A strict rules laid when dealing
the patients in the operation
theatre and other procedures
such as wound dressing and
insertion of IV and urinary
catheters.
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CLEANING AND DISINFECTION
Basic cleaning, waste
disposal, and laundry carry
priority.
The use of chemical
disinfectants for wall floors,
and furniture is warranted
in special circumstances,
such as spillages, of body
fluids from patients with
blood born viral infections
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All the Mop heads and cloths used in crucial areas should be heat disinfected and stored in dry places after use.
Bed pans washers and disinfectants and dishwashers should be monitored to ensure reliable performance
CARE OF MOP HEADS AND OTHER
ITEMS
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Hand washing is a most
important procedure
which should be
practiced by health care
worker, gram – ve
bacteria on the hands
of the staff is an
important factor in the
spread of hospital
infection
SKIN DISINFECTION AND
ANTISEPTICS
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HAND WASHING Thorough hand washing
after any procedure
involving nursing care or
close contact with the
patient is essential.
Alchool based hand
antiseptics gaining
importance where washing
with water and soap are
not practicable.
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Gloves may be worn for
any dirty contact
procedure such as
emptying a urinary
cans, or bed pans,
however it should not
be forgotten gloved
hand may also become
colonized by transient
hospital flora.
WEARING A GLOVE
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DISINFECTION POLICIES
All the hospitals should create disinfection policies which suit circumstances and economic resources.
The procedures and products should have a limited range of options, and chemicals to be used only in desired circumstances.
The policies should take into consideration surgical instruments, heat disinfection, Laundry, crockery and cleaning of floors and furniture.
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IMPORTANCE OF STAFF
Staff should have well understood responsibilities.
Effective implementation of policy requires , motivated staff, with training,
Regular updating as new methods become available
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PROPHYLACTIC ANTIBIOTICS
Wide spread and haphazard use of antibiotics hasten emergence of antibiotic resistant bacteria.
Rational antibiotic prophylaxis plays an important role in infection control
Antibiotic policy limits the use of broad spectrum agents, and is important in both prophylaxis and treatment.
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Different activities
within the hospital
require different
degrees of protection to
staff and patients.
In operation theatre the
wearing of sterile
gowns, gloves, head
gear and face mask
minimizes the shedding
of microorganisms.
PROTECTIVE CLOTHING
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BARRIER NURSING
Barrier nursing is highly
essential when soiling
of clothing is
anticipated, and dealing
with communicable
diseases, eg in EBOLA
and MARBURG
infections.
Doctorrao’s ‘e’ learning series Doctorrao’s ‘e’ learning series
DR.T.V.RAO MD 54
OTHER MEASURES
Gloves, face mask, and
goggles are indicated in
specific procedures.
The use of the above
should confirm to
international standards
and the staff should be
trained in their proper
use and disposal
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ISOLATION IN INFECTIOUS DISEASES
Practiced as a source isolation and to protect the susceptible or immunocompromised.
It needs a highly disciplined approach by all staff to ensure that none of the barriers to transmission are breached.
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CUBICLE ISOLATION
In which patient nursed alone in a room separated by door and corridor from other patients confers a substantial measures of protection.
Desirable to supply clean, filtered air is supplied to room with facilities for own toilet and washing facilities
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In some critical situations such as bone marrow transplant units, where air borne contamination with environmental fungal spores is a problem the efficiency of an air filtration may be increased and laminar airflow maintained as barrier around the patient
CRITICAL SITUATIONS
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TREXLER ISOLATOR
Stringent isolation such as a plastic tent or Trexler isolator, is required only for patients with highly contagious infections.
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HOSPITAL BUILDING AND DESIGN
Routine maintenance of the Hospital building is important, ensuring that surfaces wherever possible are smooth, impervious and easy to clean.
All constructions around the existsting Hospitals generate fungal spores and bacterial spores with have impact on specialized units serving immunocompromised patients
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LEGIONNAIRES’ DISEASE
PREVENTION
The risk of Legionnaires’ disease is reduced by regular flushing all outlets and installing water supplies that circulate below 200c for the cold and above 600c for the hot circuit
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EQUIPMENT All the equipment in
contact with patients need
decontamination and
sterilization
Heat is a preferred
method.
However heat sensitive to
the sterilized with
chemical and other newer
emerging methods
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All health care workers should screened for possible communicable diseases before employment, and offered immunization against Hepatitis B Viral infection.
An education on Universal Health Precautions is highly essential
PERSONNEL CARE OF HEALTH
CARE WORKERS
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NEEDLE STICK INJURIES
Who sustain needle
stick injuries from
potentially
contaminated sources
should have access to
advise and post
exposure
prophylaxis with
antiviral agents or
immunization.
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MONITORING OF THE ENVIRONMENT ?
Routine Microbiological monitoring of the environment is of little benefit,
But monitoring of the Air conditioning plants, and machinery used for disinfection and sterilization is essential
”
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Microbiological screening of staff and patients not undertaken routinely but it may be needed for specific purpose to detect carriers or MRSA and Hepatitis viruses in those performing some types of surgery or where transmission to patients has occurred.
SCREENING OF STAFF OR PATIENTS
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The detection and
identification of hospital
infection incidents or
outbreaks rely on the
laboratory data that
alert the infection
control team to unusual
cluster of infection,
called as ‘alert
organism’ system.
SURVEILLANCE AND ROLE OF
MICROBIOLOGY LABORATORIES
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SURVEILLANCE
Identification of MRSA & ESBL and timely information to clinicians will help the ongoing events in the Hospital warrant to track the events on source of outbreaks and action to control the similar situations in future
·
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Regular visits to wards are also important to record data on infected patients from whom no specimens have been received and to respond to problems as they occur.
Such visits will bring in grater human interaction with paramedical staff and deliver the practical teaching.
·
PRACTICAL TEACHING TO STAFF
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EFFICACY OF INFECTION CONTROL
The Following measures will certainly control the infections
1 Sterilization
2 Hand washing
3 Closed drainage systems for urinary catheters.
” 4 Intravenous catheter care
5 Peri operative antibiotic prophylaxis for contaminated wounds, and care of equipment used in respiratory therapy.
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MEASURES PROVED TO BE INEFFECTIVE
Chemical disinfection
of floors, walls, and
sinks
Routine
environmental
monitoring is losing
its concerns.
”
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Effective surveillance
and action by the
infection control team
have shown to reduce
infection rates.
One important role of
the team is to monitor
compliance and
practices known to be
effective.
WHAT IS MOST IMPORTANT
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With raising
economic costs in
running safe
hospitals eliminate
the many rituals or
less effective
practices that they
may even increase
the incidence or cost
of cross infection.
SAVING THE COSTS IN PREVENTION IF
INFECTIONS
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