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001 basic - epidemiology& principles prime 2015
This document discusses healthcare-associated infections (HAIs), also known as nosocomial infections. It defines HAIs as infections acquired within a healthcare facility, occurring 48 hours or more after admission. Common types of HAIs include urinary, respiratory, gastrointestinal, and bloodstream infections. The prevalence of HAIs globally ranges widely from under 5% to over 50% of patients. Risk factors that promote HAIs include advanced age, prolonged hospitalization, surgery, and immunosuppressive conditions or treatments. HAIs increase costs for patients, healthcare facilities, and healthcare systems through longer hospital stays, repeat hospitalizations, and in some cases mortality. Strict infection control practices are needed to reduce the risk of HAIs.
001 basic - epidemiology& principles prime 2015
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- 2. INFECTIONINFECTION ““the state orcondition in which thethe state or condition in which the body or part of the body is invadedbody or part of the body is invaded by a pathogenic agent (bacteria,by a pathogenic agent (bacteria, virus, parasites etc.) which undervirus, parasites etc.) which under favorable conditions multiplies andfavorable conditions multiplies and produces effects which areproduces effects which are injurious...”injurious...”
- 3. Nosocomial InfectionNosocomial Infection •““hospital acquired “hospital acquired “ • ““hospital-associated”hospital-associated” • ““healthcare-associated”healthcare-associated” • infections that are causedinfections that are caused by microorganisms andby microorganisms and acquired within theacquired within the healthcare facilityhealthcare facility
- 4. Nosocomial InfectionNosocomial Infection Infectionacquired 48 hoursInfection acquired 48 hours after admission to hospitalafter admission to hospital • should not be present on admission • acquired while in the healthcare facility • May manifest after discharge
- 5. Types of NosocomialTypesof Nosocomial InfectionInfection UrinaryUrinary RespiratoryRespiratory GastrointestinalGastrointestinal Blood streamBlood stream Skin, Wound, BurnSkin, Wound, Burn Surgical wound infectionSurgical wound infection OthersOthers
- 6. Healthcare-associated InfectionsHealthcare-associated Infections PREVALENCE/PREVALENCE / INCIDENCEINCIDENCE < 5% - > 50%< 5% - > 50% Infection Control Rate in Philippine Hospitals
- 8. Pooled Cumulative IncidenceDensity Of HCAI And Device-associated Infection In Adult ICU Patients In High-, Middle- And Low-income Countries Burden of Endemic Health Care-Associated Infections, A systematic review of the literature, WHO Report 2011 2.5x higher
- 9. Comparison of Localand International HCAI Data SHIP NHSN INICC FC-UTI 1.91 3.4 6.1 CL Associated Bloodstream Infection 2.76 1.5 7.4 Ventilator Associated Pneumonia 11.2 2.2 14.7 SHIP - Surveillance of Hospital Acquired Infection in the Philippines, Philippine Hospital Infection Control Society, Inc. NHSN - Hational Healthcare Safety Network, CDC, USA INICC - International Nosocomial Infection Control Consortium, Dr David Rosenthal
- 10. Hospital Wide SurveillanceComponentHospital Wide Surveillance Component and Medians of Hospital Overall Rateand Medians of Hospital Overall Rate RATE 3.5 5.1 6.4 6.4 0.9 0.4 14 0.4 0 2 4 6 8 10 12 14 RATE Medicine Burn Trauma Gen. Surg. Neurosurgery Obstetrics Pediatrics High risk nursery Well baby nursery
- 11. Distribution of MajorInfection Sites from allDistribution of Major Infection Sites from all patients and Major services, Hospital-Widepatients and Major services, Hospital-Wide Component, NNIS SystemComponent, NNIS System Infection ALL PERCENT OF CASES TYPE HOSPITAL General Surgery N=26,408 Medical N=26,178 Newborn N=3,220 UTI 33.1 30.2 42.1 4.2 Pneumonia 15.5 16.4 17.0 14.9 SSI 14.8 24.5 2.3 1.8 Others 23.4 19.4 23.8 43.1
- 12. Distribution of MajorInfection Sites from allDistribution of Major Infection Sites from all patients and Major services, Hospital-Widepatients and Major services, Hospital-Wide Component, NNIS SystemComponent, NNIS System Infection ALL PERCENT OF CASES TYPE HOSPITAL OB N=2,931 Gynecology N=1,882 Pediatric N=1,586 UTI 33.1 16.5 39.7 12.7 Pneumonia 15.5 2.3 6.5 12.7 SSI 14.8 45.0 37.2 6.1 Primary SSI 13.1 2.2 3.9 29.7 Others 23.4 34.0 12.7 38.8
- 13. Factors PromotingFactors Promoting NosocomialInfectionNosocomial Infection AgeAge Duration of hospitalizationDuration of hospitalization Surgery (type of operation)Surgery (type of operation) Immune status: chemotherapy, radiation therapy,Immune status: chemotherapy, radiation therapy, malignancymalignancy Diagnostic technique and proceduresDiagnostic technique and procedures EnvironmentEnvironment PersonnelPersonnel PatientPatient OthersOthers
- 14. The “C ST”ofThe “C ST” of Hospital-Acquired InfectionHospital-Acquired Infection PERSONNELPERSONNEL Hospitalization, etc.Hospitalization, etc. Income lossIncome loss Repeat hospitalizationRepeat hospitalization DisfigurementDisfigurement DisabilityDisability Pain, suffering etc.Pain, suffering etc. DeathDeath
- 15. The “C ST”ofThe “C ST” of Hospital-Acquired InfectionHospital-Acquired Infection INSTITUTIONSINSTITUTIONS Loss of RevenueLoss of Revenue Extra duty and Time CostsExtra duty and Time Costs Liability InsuranceLiability Insurance MalpracticeMalpractice ReputationReputation
- 16. The “C ST”ofThe “C ST” of Hospital-Acquired InfectionHospital-Acquired Infection NationalNational PatientsPatients InfectionsInfections Days in HospitalDays in Hospital COSTCOST
- 17. The “C ST”ofThe “C ST” of Hospital-Acquired InfectionHospital-Acquired Infection 5-10% incidence of nosocomial5-10% incidence of nosocomial infectioninfection $550.00 average cost per infection$550.00 average cost per infection (USA)(USA) 7.4 average extra days in hospital7.4 average extra days in hospital $600-$2,000 extra direct hospital cost$600-$2,000 extra direct hospital cost
- 18. How do infectionsoccur inHow do infections occur in the Hospital Setting ?the Hospital Setting ?
- 19. How do Infectionsoccur inHow do Infections occur in Hospital Setting ?Hospital Setting ? SOURCE/SOURCE/ AGENTAGENT SusceptibleSusceptible HOSTHOST Environment/Environment/ Means ofMeans of TransmissionTransmission
- 20. Sources of InfectionSourcesof Infection EXOGENOUSEXOGENOUS • HandsHands • InstrumentsInstruments • CathetersCatheters • Respiratory equipmentRespiratory equipment • TransfusionsTransfusions • IV systemIV system • LinenLinen • AirAir
- 21. EndogenousEndogenous Sources of InfectionSourcesof Infection Oro - PharynxOro - Pharynx RespiratoryRespiratory GastrointestinalGastrointestinal S K I NS K I N
- 22. Causative AgentsCausative Agents GRAMNEGATIVE RODS GRAM POSITIVE COCCI OTHERS Escherichia coli Staphylococcus aureus Fungi - Candida sp.; Aspergillus sp. Klebsiella sp. Staphylococcus epidermidis Protozoans Pseudomonas aeruginosa Enterococci Mycobacterium tuberculosis Acinetobacter sp. Pneumocystis carinii Enterobacter sp. Anaerobes
- 23. Factors PromotingFactors Promoting EndogenousInfectionEndogenous Infection OperationsOperations CathetersCatheters Foreign bodiesForeign bodies ChemotherapyChemotherapy Immuno-Immuno- suppressionsuppression Pre-existingPre-existing diseasedisease
- 24. SOURCE Means of Transmission Susceptible Host AnimateAnimate InanimateInanimate CONTACTCONTACT • DirectDirect •IndirectIndirect • DropletDroplet AIRBORNEAIRBORNE VEHICLEVEHICLE VECTORVECTOR DiseaseDisease TherapyTherapy NaturalNatural ConditionsConditions
- 25. SOURCE OF INFECTIONSOURCEOF INFECTION What is the degree of contamination inWhat is the degree of contamination in the person or object ?the person or object ? What is the virulence of the organism ?What is the virulence of the organism ? What conditions are present in the objectWhat conditions are present in the object or person that favor survival and growthor person that favor survival and growth of microorganisms ?of microorganisms ? What kind of contact will the object orWhat kind of contact will the object or person have with the potential host ?person have with the potential host ?
- 26. SOURCE OF INFECTIONSOURCEOF INFECTION What is the degree of contaminationWhat is the degree of contamination in the person or object ?in the person or object ? ““contamination is heavier with wetcontamination is heavier with wet objects that dry objects...”objects that dry objects...”
- 27. SOURCE OF INFECTIONSOURCEOF INFECTION What is the virulence of theWhat is the virulence of the organism ?organism ? ““As a general rule: the MORE virulentAs a general rule: the MORE virulent the organisms, the LESS the numberthe organisms, the LESS the number needed to produce the disease...”needed to produce the disease...”
- 28. SOURCE OF INFECTIONSOURCEOF INFECTION What conditions are present in the objectWhat conditions are present in the object or person that favor survival and growthor person that favor survival and growth of microorganisms ?of microorganisms ?
- 29. SOURCE OF INFECTIONSOURCEOF INFECTION What kind of exposure willWhat kind of exposure will the object or person havethe object or person have with the potential host ?with the potential host ?
- 30. MEANS OF TRANSMISSIONMEANSOF TRANSMISSION CONTACTCONTACT DROPLETDROPLET AIRBORNEAIRBORNE VEHICLEVEHICLE VECTORVECTOR
- 31. Means of TransmissionsMeansof Transmissions CONTACTCONTACT - direct or indirect- direct or indirect DROPLETDROPLET - > 5um- > 5um AIRBORNEAIRBORNE - droplet nuclei; residue- droplet nuclei; residue from evaporated dropletsfrom evaporated droplets VECTORVECTOR - insects or animals- insects or animals VEHICLEVEHICLE - food, water, blood,- food, water, blood, medicationmedication
- 32. Means of TransmissionsMeansof Transmissions CONTACTCONTACT - most common means of transmitting- most common means of transmitting microorganisms from one person to anothermicroorganisms from one person to another A. Direct ContactA. Direct Contact - occurs when one person touches another- occurs when one person touches another - direct contact is an ongoing process in the- direct contact is an ongoing process in the hospitalhospital - best vehicle : Hands- best vehicle : Hands B. Indirect ContactB. Indirect Contact - occurs when a person touches an inanimate- occurs when a person touches an inanimate object contaminated by an infected patientobject contaminated by an infected patient
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- 34. Factors that alterHostFactors that alter Host SusceptibilitySusceptibility Chronic underlying diseasesChronic underlying diseases Immune deficiency statesImmune deficiency states MalignanciesMalignancies Therapeutic measuresTherapeutic measures ImmunosuppressionImmunosuppression Antibiotic therapyAntibiotic therapy Insertion or application of devicesInsertion or application of devices SurgerySurgery AGEAGE
- 35. SOURCE Means of Transmission Susceptible Host AnimateAnimate InanimateInanimate CONTACTCONTACT • DirectDirect •IndirectIndirect • DropletDroplet AIRBORNEAIRBORNE VEHICLEVEHICLE VECTORVECTOR DiseaseDisease TherapyTherapy NaturalNatural ConditionsConditions
- 36. SOURCESOURCE SusceptibleSusceptible HOSTHOST Means ofMeans of TransmissionTransmission INFECTIONINFECTION ISOLATIONTECHNIQUE Animal and Insect Control Nursing and Medical Management Infection Control Policies and Procedures Patient Care Handling of supplies and equipment
- 37. Improvement ofImprovement of HostResistanceHost Resistance Decreasing the contact of theDecreasing the contact of the immunocompromised host toimmunocompromised host to potential pathogens throughpotential pathogens through protective or reverse isolationprotective or reverse isolation methodsmethods
- 38. Improvement ofImprovement of HostResistanceHost Resistance Avoiding orAvoiding or removing factors thatremoving factors that impair host defenses.impair host defenses. Invasive devicesInvasive devices should be avoided orshould be avoided or should be removedshould be removed as soon as possible.as soon as possible.
- 39. Improvement ofImprovement of HostResistanceHost Resistance Immunotherapy, immunizations andImmunotherapy, immunizations and other methods of reconstitutingother methods of reconstituting patients’ immune response maybepatients’ immune response maybe attemptedattempted
- 40. Improvement ofImprovement of HostResistanceHost Resistance Early recognition and treatment ofEarly recognition and treatment of infections, and the utilization ofinfections, and the utilization of ancillary measures such as exerciseancillary measures such as exercise therapy to hasten recovery oftherapy to hasten recovery of patientspatients
- 41. SOURCESOURCE SusceptibleSusceptible HOSTHOST Means ofMeans of TransmissionTransmission INFECTIONINFECTION ISOLATIONTECHNIQUE Animal and Insect Control Nursing and Medical Management Infection Control Policies and Procedures Patient Care Handling of supplies and equipment
- 42. Minimizing theMinimizing the RISKof INFECTIONRISK of INFECTION • The environment should be HOSTILEThe environment should be HOSTILE to the multiplication of pathogensto the multiplication of pathogens i.e. clean, dry and well ventilatedi.e. clean, dry and well ventilated
- 43. Minimizing theMinimizing the RISKof INFECTIONRISK of INFECTION • All instruments and equipmentAll instruments and equipment should be clean and dry.should be clean and dry. • Invasive items should be sterilizedInvasive items should be sterilized and items in contact with mucousand items in contact with mucous membranes, body fluids andmembranes, body fluids and potentially infectious materialspotentially infectious materials should be disinfected.should be disinfected.
- 44. Minimizing theMinimizing the RISKof INFECTIONRISK of INFECTION • The hands should be washed afterThe hands should be washed after handling infectious materials (e.g.handling infectious materials (e.g. bed linen, dressings, secretion andbed linen, dressings, secretion and excretions) and before aseptic orexcretions) and before aseptic or surgical procedures.surgical procedures. • The skin of the patient should beThe skin of the patient should be disinfected before invasivedisinfected before invasive procedures.procedures.
- 45. Minimizing theMinimizing the RISKof INFECTIONRISK of INFECTION • EmphasizeEmphasize HANDWASHINGHANDWASHING forfor personal hygienepersonal hygiene
- 46. Minimizing theMinimizing the RISKof INFECTIONRISK of INFECTION • All infectious materials (e.g. linen,All infectious materials (e.g. linen, clinical waste, sharps) should beclinical waste, sharps) should be safely contained, decontaminated orsafely contained, decontaminated or destroyeddestroyed
- 47. Minimizing theMinimizing the RISKof INFECTIONRISK of INFECTION • Food should be hygienicallyFood should be hygienically prepared, properly cooked andprepared, properly cooked and stored at low temperatures until usedstored at low temperatures until used
- 48. Minimizing theMinimizing the RISKof INFECTIONRISK of INFECTION • Susceptible patients or sites should beSusceptible patients or sites should be protected from pathogenicprotected from pathogenic microorganisms: i.e. dressing, isolation,microorganisms: i.e. dressing, isolation, barrier, nursingbarrier, nursing • The resistance of susceptible host shouldThe resistance of susceptible host should be enhanced when possible: vaccination,be enhanced when possible: vaccination, immunization and sometimes prophylacticimmunization and sometimes prophylactic antibiotics should be usedantibiotics should be used
- 49. Control Measures forHealthcare-Control Measures for Healthcare- Associated InfectionAssociated Infection Infection control measuresInfection control measures ChemoprophylaxisChemoprophylaxis ImmunoprophylaxisImmunoprophylaxis TherapyTherapy Employee Health ProgramEmployee Health Program
- 50. SOURCESOURCE SusceptibleSusceptible HOSTHOST Means ofMeans of TransmissionTransmission INFECTIONINFECTION ISOLATIONTECHNIQUE Animal and Insect Control Nursing and Medical Management Infection Control Policies and Procedures Patient Care Handling of supplies and equipment
- 51. Control Measures forControlMeasures for Nosocomial InfectionNosocomial Infection InfectionInfection ControlControl MeasuresMeasures InfectionInfection ControlControl MeasuresMeasures CHEMO-CHEMO- PROPHYPROPHY LAXISLAXIS CHEMO-CHEMO- PROPHYPROPHY LAXISLAXIS IMMUNO-IMMUNO- PROPHYPROPHY LAXISLAXIS IMMUNO-IMMUNO- PROPHYPROPHY LAXISLAXIS THERAPYTHERAPYTHERAPYTHERAPY EmployeeEmployee HealthHealth ProgramProgram EmployeeEmployee HealthHealth ProgramProgram Standard PrecautionsStandard Precautions Barrier PrecautionsBarrier Precautions Isolation PrecautionsIsolation Precautions SterilizationSterilization DisinfectionDisinfection Environmental SanitationEnvironmental Sanitation Standard PrecautionsStandard Precautions Barrier PrecautionsBarrier Precautions Isolation PrecautionsIsolation Precautions SterilizationSterilization DisinfectionDisinfection Environmental SanitationEnvironmental Sanitation
- 52. Control Measures forControlMeasures for Nosocomial InfectionNosocomial Infection InfectionInfection ControlControl MeasuresMeasures InfectionInfection ControlControl MeasuresMeasures CHEMO-CHEMO- PROPHYPROPHY LAXISLAXIS CHEMO-CHEMO- PROPHYPROPHY LAXISLAXIS IMMUNO-IMMUNO- PROPHYPROPHY LAXISLAXIS IMMUNO-IMMUNO- PROPHYPROPHY LAXISLAXIS THERAPYTHERAPYTHERAPYTHERAPY EmployeeEmployee HealthHealth ProgramProgram EmployeeEmployee HealthHealth ProgramProgram SURGICALSURGICAL NON-SURGICALNON-SURGICAL SURGICALSURGICAL NON-SURGICALNON-SURGICAL
- 53. Control Measures forControlMeasures for Nosocomial InfectionNosocomial Infection InfectionInfection ControlControl MeasuresMeasures InfectionInfection ControlControl MeasuresMeasures CHEMO-CHEMO- PROPHYPROPHY LAXISLAXIS CHEMO-CHEMO- PROPHYPROPHY LAXISLAXIS IMMUNO-IMMUNO- PROPHYPROPHY LAXISLAXIS IMMUNO-IMMUNO- PROPHYPROPHY LAXISLAXIS THERAPYTHERAPYTHERAPYTHERAPY EmployeeEmployee HealthHealth ProgramProgram EmployeeEmployee HealthHealth ProgramProgram ACTIVE IMMUNIZATIONACTIVE IMMUNIZATION PASSIVE IMMUNIZATIONPASSIVE IMMUNIZATION ACTIVE IMMUNIZATIONACTIVE IMMUNIZATION PASSIVE IMMUNIZATIONPASSIVE IMMUNIZATION
- 54. Control Measures forControlMeasures for Nosocomial InfectionNosocomial Infection InfectionInfection ControlControl MeasuresMeasures InfectionInfection ControlControl MeasuresMeasures CHEMO-CHEMO- PROPHYPROPHY LAXISLAXIS CHEMO-CHEMO- PROPHYPROPHY LAXISLAXIS IMMUNO-IMMUNO- PROPHYPROPHY LAXISLAXIS IMMUNO-IMMUNO- PROPHYPROPHY LAXISLAXIS THERAPYTHERAPYTHERAPYTHERAPY EmployeeEmployee HealthHealth ProgramProgram EmployeeEmployee HealthHealth ProgramProgram ANTIBIOTICANTIBIOTIC IMMUNOTHERAPYIMMUNOTHERAPY SUPPORTIVESUPPORTIVE ANTIBIOTICANTIBIOTIC IMMUNOTHERAPYIMMUNOTHERAPY SUPPORTIVESUPPORTIVE
- 55. Control Measures forControlMeasures for Nosocomial InfectionNosocomial Infection InfectionInfection ControlControl MeasuresMeasures InfectionInfection ControlControl MeasuresMeasures CHEMO-CHEMO- PROPHYPROPHY LAXISLAXIS CHEMO-CHEMO- PROPHYPROPHY LAXISLAXIS IMMUNO-IMMUNO- PROPHYPROPHY LAXISLAXIS IMMUNO-IMMUNO- PROPHYPROPHY LAXISLAXIS THERAPYTHERAPYTHERAPYTHERAPY EmployeeEmployee HealthHealth ProgramProgram EmployeeEmployee HealthHealth ProgramProgram Hepatitis BHepatitis B screeningscreening TB ScreeningTB Screening ImmunizationImmunization Hepatitis BHepatitis B screeningscreening TB ScreeningTB Screening ImmunizationImmunization
- 56. Principles in InfectionControlPrinciples in Infection Control The Health Care Worker (HCW) shouldThe Health Care Worker (HCW) should be aware of how infection is transmittedbe aware of how infection is transmitted and the factors involved in the process.and the factors involved in the process. The HCW should have the properThe HCW should have the proper attitude of infection control.attitude of infection control. The HCW should be able to implementThe HCW should be able to implement the MOST effective and applicablethe MOST effective and applicable measures to prevent and controlmeasures to prevent and control infection in his place of work.infection in his place of work.
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- 58. Infection Control is .....a WAY of LIFE
Editor's Notes
- #9 In this report, the occurrence of HCAIs in Low-medium income countries: 2.5 times higher than in high income countries For Catheter Related -BSI: 3.5 times Catheter Related -UTI: 2 times VAP: 3 times
- #11 Most recent recent results of INNIC, CDC and SHIP
- #33 Airborne: can remain suspended in air for significant periods of time allowing them to be transmitted over distances &gt;1 meter.
- #34 Fomites: temporary reservoir of pathogens
- #40 The Chain of Infection can be interrupted at the transmission stage by Isolation techniques based on method of spread Control of insect and rodents that serve as vectors in the spread of microorganisms Use of disposable supplies and equipment in an attempt to limit the spread of infection by this means
- #42 e.g., Delay in removing Foley cath among surgery patients
- #44 Physical rehab
- #45 The Chain of Infection can be interrupted at the transmission stage by Isolation techniques based on method of spread Control of insect and rodents that serve as vectors in the spread of microorganisms Use of disposable supplies and equipment in an attempt to limit the spread of infection by this means
- #46 Environment
- #54 The Chain of Infection can be interrupted at the transmission stage by Isolation techniques based on method of spread Control of insect and rodents that serve as vectors in the spread of microorganisms Use of disposable supplies and equipment in an attempt to limit the spread of infection by this means