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1. Aarti Sareen
MSPT Honours I
Roll No. 8
HOSPITAL ACQUIRED INFECTIONS

2. Hospital acquired infection is also
called Nosocomial infection or
Healthcare-associated infections.
"nosus" = disease
"komeion" = to take care of
Nosocomial infections can be defined
as infection acquired by the person
in the hospital, manifestation of
which may occur during
hospitalization or after discharge
from hospital. The person may be a
patient, members of the hospital
staff and/ or visitors.

4. EPIDEMIOLOGICAL INTERACTION
HOST FACTORS
Suppresed immune system due to Age, Poor
nutritional status, severity of underlying
disease, complicated diagnostic & therapeutic
procedure,therapeutic,
NCI
THE ENVIRNOMNET
Everything that surrounds the patient
THE AGENT
in the hospital is his environment.
Varieties of organisms
Other patients
Institutional and human Hospital staff and visitors
Eatables
Reservoirs & their virulence Dust and other contaminated articles

5. SOURCE OF INFECTION
Exogenous/indirect
Endogenous/direct: Caused by organisms acquiring by
exposure to hospital personnel, medical
Caused by the devices or hospital environment, cross-
infection from medical personnel
organisms that are • hospital environment- inanimate
objects
present as part of – air
normal flora of the – dust
– IV fluids & catheters
patient – washbowls
– bedpans
– endoscopes
– ventilators & respiratory equipment
– water, disinfectants etc

6. EXOGENOUS INFECTION SITES

7. The Inanimate Environment Can Facilitate Transmission
~ Contaminated surfaces increase cross-transmission ~

8. Exogenours
Pathogens

9. Nosocomial Infections:
Changing Microbiology
• Mid-1980’s • Mid-1990’s
– Enterobacteriaceae – Decline in
Enterobacteriaceae
– S. aureus
– Increase in gram-
– P. aeruginosa
positive cocci
– Emergence of fungi
– Recognition of viruses

10. All microorganisms can cause
nosocomial infections
Viruses
Bacteria
Fungi
Parasites

11. BACTERIA
Gram +ve
Staphylococcus aureus
Staphylococcus epidermidis
Gram -ve
Enterobacteriaceae
Pseudomonas aeruginosa
Acinetobacter baumanni
Mycobacterium tuberculosis

12. COMMON BACTERIAL AGENTS
Pseudomonas (9%)
aeruginosa
Enterococcus (10%)
Coag-neg staphylococcl
(11%)
E-coli
(12%)
Staphylococcus aureus
(13%)
Other
(45%)

13. Viruses
◦ Blood borne infections : HBV, HCV, HIV
◦ Others: rubella, varicella, SARS
Fungi
◦ Candida
◦ Aspergillus

14. TYPES OF INFECTIONS
– Urinary tract infections (UTI)
– Surgical wound infections (SWI)
– Lower respiratory infections
– Traumatic wounds and burns infections
– Primary bacteraemia
– Gastrointestinal tract
– Central nervous system

15. Major Types of Nosocomial Infections
35
30
25
UTI
20 Pneumonia
15 SWI
Bloodstream
10 Other
5
0 Richards, MJ. 1999.
Overall ICU Crit Care Med 27; 887.

16. Mode of trasmission
Contact/hand borne (most common)
Aerial route or air borne
Oral route
Parenteral route
Vector borne

17. 1. Contact (most common)
Direct (physical contact)
– Hands & clothing
– Droplet contact followed
by autoinoculation
– Clinical equipment
Indirect via contaminated articles
– Bedpans,
– bowls, jugs,
– Instruments like needles,
– dressings,
– contaminated gloves,etc.

18. 2. Airborne Transmission
– Droplet respiratory secretions on surfaces
– Inhalation of infectious particles
e.g. (TB, Varicella)
3. Oral route
4. Parenteral route
5. Vector borne: through mosquitoes, flies,
rats

19. Pathogens transmission

20. The hands are the most important
vehicle of transmission of
HCAI

21. Why
Don’t Staff Wash
their Hands
(Compliance estimated at less than 50%)

22. Why Not?
• Skin irritation
• Inaccessible hand washing facilities
• Wearing gloves
• Too busy
• Lack of appropriate staff
• Being a physician
(“Improving Compliance with Hand Hygiene in Hospitals” Didier Pittet. Infection
Control and Hospital Epidemiology. Vol. 21 No. 6 Page 381)

23. Hand Hygiene Techniques
1. Alcohol hand rub
2. Routine hand wash 10-15 seconds
3. Aseptic procedures 1 minute
4. Surgical wash 3-5 minutes

24. Routine Hand Wash
Repeat procedures until hands are clean

25. Areas Most Frequently Missed
HAHS © 1999

26. Hand Care
• Nails
• Rings
• Hand creams
• Cuts & abrasions
• “Chapping”
• Skin Problems

27. Hand hygiene is the
simplest, most effective
measure for preventing
hospital-acquired
infections.

28. Surveillance

29. Why surveillance?
• NCI cause of morbidity and mortality
• One third may be preventable
• Surveillance = key factor
– an infection control measure
– overview of the burden and distribution of NCI
– allocate preventive resources
• Surveillance is cost-efficient!!

30. Objectives
• Reducing infection rates
• Establishing endemic baseline rates
• Identifying outbreaks
• Identifying risk factors
• Persuading medical personnel
• Evaluate control measures
• Satisfying regulators
• Document quality of care
• Compare hospitals’ NCI rates

31. The surveillance loop
Health care Surveillance centre
system
Reporting
Event Data
interpretation
Analysis,
Action Information
Feedback,
recommendations

32. Considerations when creating a
surveillance system
• Goal of the surveillance system (why)
• Engage the stakeholders (who)
• Surveillance method (what, how, when)
– definition
– what to collect
– how to collect (operation of system)
• Available resources

33. Who
• All hospitals?
• All departments?
• All specialties?
• Other health institutions?

34. Stakeholders
Central
adm. Local
…..
adm.
Public
Health ICP
instituteI
It-
Directorat
Surveillance of dep.
surgical site infections
Ministry Surgical
Of health wards
Service Surgical
dep. ward. 2
Lab Patients

36. Control of NCI

37. Goals for infection control and hospital
epidemiology
There are three principal goals for hospital infection
control and prevention programs:
1. Protect the patients
2. Protect the health care workers, visitors, and others
in the healthcare environment.
3. Accomplish the previous two goals in a cost
effective and cost efficient manner, whenever
possible.
.

38. To control the
nosocomial
infection we need
to consider the
chain of infection
and the
transmission of an
infectious agent

39. Prevention & control of nosocomial
infections
– observance of aseptic technique
– frequent hand washing especially between
patients
– careful handling, cleaning, and disinfection of
fomites
– where possible use of single-use disposable
items
– patient isolation
– avoidance where possible of medical procedures
that can lead with high probability to nosocomial
infection (urinary catheter)

40. Prevention & control of nosocomial infections
(cont.)
– Various institutional methods such as air filtration
within the hospital
– Appropriate isolation precautions to protect
patients, visitors, and HCWs.
– Surveillance for common infections, monitoring of
high risk patients, and hospital area to identify
outbreaks, document incidence and prevalence
rate of specific infections and set goal for
improvement.

41. Uttermost care should be taken in following
services:
• House keeping
• Dietary services
• Linen and laundry
• Central sterile supply department
• Nursing care
• Waste disposal
• Antibiotic policy
• Hygiene and sanitation

42. Isolation & barrier precautions
Decontamination of equipment
Prudent use of antibiotics
Hand washing
Decontamination of environment
The 5 pillars of infection control

43. Infection Control Committee

44. Infection control Committee (ICC):
The hospital ICC is charged with the
responsibility for the planning, evaluation of
evidenced-based practice and
implementation, prioritization and resource
allocation of all matters relating to infection
control.

45. Infection Control Team
Infection Control Doctor (ICD) Infection Control Nurse (ICN)

46. Role of infection control teams
• Education and training
• Development and dissemination of
infection control policy
• Monitoring and audit of hygiene
• Clinical audit