1. INFECTION
CONTROL
Dr.T.V.Rao MD
Professor of Microbiology
DR.T.V.RAO MD 1

2. A TRIBUTE TO
IGNAZ SEMMELWEISS (1818-1865)
Ignaz Semmelweiss (1818-1865)
• Obstetrician, practised in
Vienna
• Studied puerperal (childbed)
fever
• Established that high
maternal mortality was due
to failure of doctors to wash
hands after post-mortems
• Reduced maternal mortality
by 90%
• Ignored and ridiculed by
colleagues
DR.T.V.RAO MD 2

3. HOSPITAL INFECTIONS ARE
EMERGING CHALLENGES IN
HEALTH CARE
• Hospital-associated infections
represent a serious and growing health
problem. The Centers for Disease
Control and Prevention (CDC)
estimates that 2 million people acquire
hospital-associated infections each
year and that 90 000 of these patients
die as a result of their infections. A
variety of hospital-based strategies
aimed at preventing such infections
have been proposed.
DR.T.V.RAO MD 3

4. WHAT IS INFECTION
CONTROL
• Infection control is the discipline concerned
with preventing nosocomial or healthcare-associated
infection. As such, it is a practical
(rather than an academic) sub-discipline of
epidemiology. It is an essential (though often
under-recognized and under-supported) part
of the infrastructure of health care. Infection
control and hospital epidemiology are akin to
public health practice, practiced within the
confines of a particular health-care delivery
system rather than directed at society as a
whole.
DR.T.V.RAO MD 4

5. BEGINNING OF HOSPITAL
INFECTION PROGRAMME
• Modern hospital infection
control programs first began in
the 1950s in England, where
the primary focus of these
programs was to prevent and
control hospital-acquired
staphylococcal outbreaks. In
1968, the American Hospital
Association published
"Infection Control
in the Hospital,"
the first and only standards
available for many years.
DR.T.V.RAO MD 5

6. BEGINNING OF
ACCREDITATION
• In 1969, the Joint
Commission for
Accreditation of
Hospitals--later to
become the Joint
Commission on
Accreditation of
Healthcare
Organizations
(JCAHO)--first
required hospitals to
have organized
infection control
committees and
isolation facilities.
DR.T.V.RAO MD 6

7. CDC INITIATES HOSPITAL
INFECTION BRANCH
• In 1972, the Hospital
Infections Branch at
the CDC was formed
and the Association for
Practitioners in
Infection Control was
organized. By the
close of the decade,
the first CDC
guidelines were written
to answer frequently
asked questions and
establish consistent
practice. DR.T.V.RAO MD 7

8. INFECTION CONTROL
CHALLENGES OF
HEALTHCARE IN 2000
• Decreasing reimbursement
• Increasing emerging infections
• Increasing resistant organisms
• Increasing drug costs
• Institute of Medicine Report--healthcare-associated
infections
• Nursing shortage
• OSHA safety legislation
• Multiple benchmark systems
• FDA legislation on reuse of single-use devices
DR.T.V.RAO MD 8

9. WHY EVERYONE CONCERNED
WITH HOSPITAL INFECTIONS
• The Centers for
Disease Control (CDC)
estimates that 2 million
U.S. patients a year
acquire hospital-related
infections.
These infections cost
an average of $47,000
per patient to treat and
cause 90,000 deaths
each year. The added
cost to hospitals is
$4.8 billion annually in
extended care and
treatment.
DR.T.V.RAO MD 9

10. DEVELOPING INFECTION
CONTROL PROGRAMME
• Every infection control program should
develop a well-defined written plan outlining
the organizational philosophy regarding
infection prevention and control. The plan
should take into account the goals, mission
statement, and an assessment of the infection
control program. It should include a statement
of authority, and should review patient
demographics including geographic locations
of DR.patients T.V.RAO MD served by the healthcare system
10

11. SURVEILLANCE
• The surveillance is the
cornerstone of the infection control
practice because it allows to
identify the areas where the
outcomes are below expectations
and we can improve.
• Examples of centrally driven
surveillance include MRSA
bacteraemia surveillance
DR.T.V.RAO MD 11

12. 12
KEY ELEMENTS OF
SURVEILLANCE
• Defining as precisely as possible the event
to be surveyed (case definition)
• Collecting the relevant data in a
systematic, valid way
• Consolidating the data into meaningful
arrangements
• Analyzing and interpreting the data
• Using the information to bring about
adapted from R. Haley
change
DR.T.V.RAO MD

13. SURVEILLANCE
• The key to ongoing
monitoring is
surveillance for
nosocomial infections.
Various techniques for
surveillance have
been described and
evaluated including
total house
surveillance, targeted
surveillance, Kardex,
or laboratory-base
DR.T.V.RAO MD 13

14. 14
AREAS OF INTEREST TO A
HEALTHCARE EPIDEMIOLOGIST
• Surveillance for
nosocomial infection
• Patterns of
transmission of
nosocomial infections
• Outbreak
investigation
• Isolation precautions
• Evaluation of
exposures
• Employee health
• Disinfection and
sterilization
• Hospital engineering
and environment
• water supply
• air filtration
• Reviewing policies and
procedures for
patient care
DR.T.V.RAO MD

15. EDUCATIONAL
PSYCHOLOGY
• Most difficult part of infection control
practioners is overcome the reluctance of
humans to change their behaviour
• Every one knows importance of hand hygiene
and sterile technique
• However hand hygiene compliance is poor
among health care workers and even after
intensive education and improved marginally
DR.T.V.RAO MD 15

16. STAFF TRAINING IN
ICP
• Education programs for
employees and volunteers are
one method to ensure
competent infection control
practices. It is a unique
challenge since employees
represent a wide range of
expertise and educational
background. The ICP must
become knowledgeable in
adult education principles and
use educational tools and
techniques that will motivate
and sustain behavioral change.
DR.T.V.RAO MD 16

17. 17
ORGANIZING FOR
INFECTION CONTROL
• Requires cooperation, understanding and
support of hospital administration and
medical/surgical/nursing leadership
• There is no simple formula:
• Every facility is different
• Every facility’s problems are different
• Every facility’s personnel are different
• The facility must develop its own unique
program
DR.T.V.RAO MD

18. DOCUMENT ANTIBIOGRAMS
WITH WHONET
• WHONET is a free
Windows-based
database software
developed for the
management and
analysis of
microbiology
laboratory data with
a special focus on
the analysis of
antimicrobial
susceptibility test
results.
DR.T.V.RAO MD 18

19. ANTIBIOTIC
STEWARDSHIP
• It carries
considerable
interest in
implementing
and monitoring
interventions to
optimize
prescribing of
antimicrobial
drugs
DR.T.V.RAO MD 19

20. DR.T.V.RAO MD 20

21. CAN WE CHANGE THE
SITUATION?
• Antibiotic policies
may be introduced
primarily to reduce
total Antibiotic use
to reduce in
appropriate
prescribing
• Many using the
most broad
spectrum drugs in
the first line ?
DR.T.V.RAO MD 21

22. USE OF ANTIBIOTIC
POLICIES
• It has been estimated that up to 50
% of the antimicrobial prescribing is
inappropriate in terms of choice,
duration and indication of
treatment.
• The coordination of clinician and
microbiologist to reduce in
implementation of antibiotic
guidelines carries a higher
DR.T.V.RAO MD 22

23. ALERT MICROBES
• Hospital acquired alert organisms
generally those organisms that have
resistance to a range of antibiotics and
are capable of spreading
• Methicillin resistant Staphylococcus
aureus
• Gram negative bacilli resistant to
gentamicin, extended spectrum beta
lactamases
• Vancomycin resistant Enterococci
DR.T.V.RAO MD 23

24. ALL ISOLATES
• All positive isolates clinical isolates
from high risk areas Intensive care
areas Intensive care areas special care
baby units
• Positive clinical isolates from sites of
interest to infection control team (
catheter related infections,
• Urinary and Intravascular operative
samples
• Removed prosthesis, heart valves ,
DR.T.V.RAO MD 24

25. ESKAPE -
BACTERIA
• ESKAPE bacteria—
Enterococcus faecium,
Staphylococcus
aureus,
Klebsiella species,
Acinetobacter
baumannii,
Pseudomonas
aeruginosa, and
Enterobacter species—
are among the biggest
threat of infectious
diseases physicians face
today,
DR.T.V.RAO MD 25

26. ESKAPE
BACTERIA ARE MAJOR NOSOCOMIAL
AGENTS
• According to
the latest data from
the Centers for
Disease Control
and Prevention
(CDC), the six
ESKAPE bacteria
are responsible for
two thirds of all
health care-associated
DR.T.V.RAO MD 26

27. WHAT IS BEST FOR HAND
HYGIENE
• A single application of 60 – 70 % Ethanol or
Isopropanol with emolument and with or with
out antiseptic like
• 1 Chlorhexidine
• 2 Povidone –iodine
• Triclosan
• Proved to be more effective than soap and
water
DR.T.V.RAO MD 27

28. HOW YOU RUB YOUR
HANDS
• A volume
of 3 ml is
pored into
cupped
hands and
rubbed to
dryness
DR.T.V.RAO MD 28

29. IF YOUR HANDS ARE
SOILED
• Do not forget
to a preliminary
wash with soap
or detergent
and water is
required before
the application
of Alcoholic
solution
DR.T.V.RAO MD 29

30. WHY WE NEED
COMPUTERS
• The use of technology rather than manual
system should enable data to be Analysed
more easily and encouraged.
• So many soft wares in market
• But should be compatible with clinical
laboratory system and integrate with hospital
information technology patient management
system in order to obtain with meaningful
data with minimal effort.
DR.T.V.RAO MD 30

31. INFECTION CONTROL PROGRAMME
AND DOCUMENTATION
• Goals of the infection
control program need
to be incorporated into
the mission statement
of the facility. A mission
statement should tell
who you are, what you
do, and should
communicate a clear
view of purpose and
set a strategy for
accomplishing the goal
DR.T.V.RAO MD 31

32. GOOD HOUSE KEEPING A
BOON TO INFECTION
CONTROL
DR.T.V.RAO MD 32

33. BREAK THE CHAIN OF
INFECTIONS
• 1. Organisms that
can cause infection
are subject to risk
assessment under
the COSHH
regulations and
Management of
Health and Safety
at Work Regulation
1992.
DR.T.V.RAO MD 33

34. THE INFECTION CONTROL
TEAM
• Consist of at least an
infection control
practitioner who
should be trained for
the purpose; carry
out the surveillance
programme; develop
and disseminate
infection control
policies; monitor
and manage critical
incidents;
coordinate and
conduct training
activities.
DR.T.V.RAO MD 34

35. INVOLVEMENT OF PHYSICIANS
MORE IMPORTANT
Physicians to be more involved
and lead quality improvement
efforts in their respective
healthcare settings. Drs.
Pronovost and Marsteller
suggest that even though quality
improvement efforts exist, there is
not enough data supporting the
notion that quality improvement
efforts are actually enhancing
patient outcomes. One of the
reasons for this lack of progress,
they say, is inadequate physician
engagement and leadership in
quality improvement work.
Peter Pronovost, MD, PhD, and
Jill Marsteller, PhD, MP
DR.T.V.RAO MD 35

36. MAJOR RESPONSIBILITIES OF
I C P
• The major responsibilities for ICPs to
oversee include surveillance, specific
environmental monitoring, continuous
quality improvement, consultation,
committee involvement, outbreak and
isolation management, regulatory
compliance and education. To plan,
coordinate, and succeed in fulfilling these
responsibilities, many ICPs have to redefine
their roles. More ICPs are becoming
managers by creating multidisciplinary
support teams to carry out many of the
functions.
DR.T.V.RAO MD 36

37. INVOLVEMENT OF
PHYSICIANS MORE
IMPORTANT
Physicians to be more involved
and lead quality improvement
efforts in their respective
healthcare settings. Drs.
Pronovost and Marsteller
suggest that even though quality
improvement efforts exist, there
is not enough data supporting
the notion that quality
improvement efforts are actually
enhancing patient outcomes.
One of the reasons for this lack
of progress, they say, is
inadequate physician
engagement and leadership in
quality improvement work.
Peter Pronovost, MD, PhD, and
Jill Marsteller, PhD, MP
DR.T.V.RAO MD 37

38. GUIDELINES AND
RECOMMENDATIONS
• Hand washing and
Hospital
Environmental
Control
* Immunization
* Infectious Diseases
Control
* Intravascular
Device-Related
Infections and its
control
* Isolation
Precautions
DR.T.V.RAO MD 38

39. SCIENTIFIC DOCUMENTATION
REDUCES HOSPITAL
INFECTIONS
• Researchers evaluated the
effect of an electronic
medical record on the
use of antimicrobial
agents and infection rates
of Clostridium difficile
and MRSA. Results
showed that
implementation of an EMR
significantly increased
chart reviews and
antimicrobial
recommendations, leading
to a decrease in
antimicrobial use and
MRSA as well as C. difficile
infection rates.
DR.T.V.RAO MD 39

40. A SAYING APPLIES TO ALL
ACTIVITIES INCLUDING HOSPITAL
SURVEILLANCE
• If you are not
measuring it, you
are not managing
it.
DR.T.V.RAO MD 40

41. • Programme Created by
Dr.T.V.Rao MD for Health
awareness on Hospital acquired
Infections
• Email
• doctortvrao@gmail.com
DR.T.V.RAO MD 41