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hospital acquired infection HAI
- 1. INSERVICE EDUCATION ON HOSPITALACQUIRED INFECTION Presented by, RevathyK D MSc Medical Surgical Nursing
- 3. • At anygiven time, 7 patients in developed and 10 in developing countries out of every 100 hospitalised patients will acquire at least one HAI
- 4. DEFINITION OF HOSPITALACQUIRED INFECTION • A hospital acquired infection –HAI also known as Nosocomial infection is an infection that is acquired in a hospital or other health care facility. • Also called Health care Associated Infection.
- 5. DEFINITION- HCAI • Infection acquiredin a hospital by a patient who was admitted for a reason other than that of infection • In whom infection was not present or incubating at the time of admission • Infection that first appear 48 hours or more after admission or within 30 days after discharge
- 7. Impact ...... – Moreserious illness – Prolonged hospital stay – Long-term disability – Mortality – Additional financial burden
- 9. Epidemiological Triad ofHAI HAI
- 10. Susceptible Host • Extremesof age • Chronic infections - Diabetes mellitus - COPD • Drug • Severe malnutrition • Immunosuppression • Trauma/ Open wound • Coma • Burns • Diagnostic/ therapeutic procedures 10
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- 12. VIRUS • Hepatitis B& C, HIV • Influenza • Rota • Varicella zoster FUNGI • Candida • Aspergillus
- 13. Environment Factors • Bothanimate & inanimate environment of patients • Air • Water • Humidity • Temperature • Sanitation • Equipments • Instruments 13
- 14. Health care environment •Water, damp areas, and occasionally sterile products or even disinfectants Appropriate housekeeping normally limits the risk of surviving bacteria as most micro organisms require humid or hot conditions and nutrients to survive
- 15. 1. Contact transmission a)Direct contact b) Indirect contact • Infectious agent is transmitted by contact with a contaminated intermediate object. • contaminated instruments/ needles/ dressings • contaminated gloves that are not changed between patients • contaminated surfaces
- 16. 2. Droplet transmission •Occurs when microorganisms come in contact with the mucus membrane of a person’s nose, mouth, eyes etc. • Microbes in droplet nuclei (> 5 μm size ) can travel only upto 1 meter ( 3 feet). • These droplets are heavy and do not remain suspended in the air for a long time to settle on surfaces due to gravity.
- 17. 3. Airborne transmission •Occurs when pathogens are transmitted to a susceptible person through inhalation of small droplet nuclei (< 5μm size) • As these particles are very light, can well disperse beyond one metre and remain air borne for long periods. On inhalation they can reach the alveoli ..
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- 19. Burden of CAUTI •10% of hospitalized patients require urinary catheterization • CAUTI- 40% of all HCAIs
- 20. CAUTI risk andduration of catheterization The risk of CAUTI is directly related to the duration of catheterization.. Every day that the urinary catheter is in place increases the patient’s risk of CAUTI up to 3- 7% per day!
- 21. Risk factors ofCAUTI • Catheter-Related Factors • Insertion technique • Catheter care • Duration of catheterization • Patient-Related Factors • Elderly age • Female gender • Renal dysfunction • Immunosuppression • Diabetes Mellitus • Fecal Incontinence
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- 24. Determinants of SSI HostEnvironment Agent
- 25. new or progressive infiltrate fever, altered WBC count worsening oxygenation changesin sputum character detectionof a causative agent Definition of VAP
- 26. Risk factors forVAP HCW RELATED Improper adherence to aseptic techniques specially hand washing PATIENT RELATED Extremes of age lung disease Obesity, Malnutrition Immunosuppression Heavy smokers Medical interventions prolonged hospitalization Mechanical ventilation Foreign body- ETT, NGT Aspiration of gastric contents General anaesthesia
- 28. • Catheter criteria- ❖Bacteremiaor fungemia in a patient who has a central venous catheter • Clinical criteria- ❖e.g., fever, chills, and/or hypotension • Culture criteria- ❖Positive blood culture result obtained from 1 CL and 1 PL. • No apparent source for bloodstream infection (other than catheter).
- 29. Sources of CLBSI Intrinsiccontamination During device or fluid production and before use Faulty sterilization (of IV fluids, drugs..) or damage during manufacture or storage Klebsiella (6%), Enterobacter or Pseudomonas (16%) Reference: Damani’s Manual of infection prevention and control, 3rd edition Extrinsic contamination At the time of insertion of catheter by the hands of the operator. Poor sterile precautions during IV fluid or drug administration Skin commensals like CoNS (31%) and S.aureus (20%), candida (9%)
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- 31. How to DiagnoseCRBSI?
- 32. What is acare bundle? ● A care bundle is a group of three to five evidence-based interventions which, when performed together, have a better outcome than if performed individually. ● Care bundles can be used to ensure the delivery of the minimum standard of care. ● They can be used as an audit tool to assess the delivery of interventions but do not assess how well individual interventions are performed. ● Care bundles should encourage the review of evidence and modification of clinical care guidelines 3 4
- 33. Bundles for theprevention of central line-associated bloodstream infections- CLABSI ● Insertion Bundle: ● Maximal sterile barrier precautions ● Skin cleaning with alcohol-based chlorhexidine ● Avoidance of the femoral vein for central venous access in adult patients ● Dedicated staff for central line insertion, and competency training/assessment. 3 5
- 34. ● Standardized insertionpacks. ● Availability of insertion guidelines (including indications for central line use) and use of checklists with trained observers. ● Use of ultrasound guidance for insertion of internal jugular lines. 3 6
- 35. Maintenance Bundle ● Dailyreview of central line necessity. ● Prompt removal of unnecessary lines. ● Disinfection prior to manipulation of the line. ● Daily chlorhexidine washes (in ICU, patients > 2 months). ● Disinfect catheter hubs, ports, connectors, etc., before using the catheter. ● Change dressings and disinfect site with alcohol-based chlorhexidine every 5-7 days (change earlier if soiled). ● Replace administration sets within 96 hours (immediately if used for blood products or lipids). ● Ensure appropriate nurse-to-patient ratio in ICU (1:2 or 1:1). 3 7
- 36. Bundle for theprevention of catheter-associated urinary tract infections- CAUTI ● Avoiding the use of urinary catheters by considering alternative methods for urine collection. ● Using an aseptic technique for insertion and proper maintenance after insertion. ● Follow evidence-based guidelines and implement catheter insertion policies at the institution ● Daily assessment of the presence and need for indwelling urinary catheters. 3 8
- 37. Bundle for theprevention of ventilator associated pneumonia (VAP) ● Elevate the head of the bed to between 30 and 45 degrees. ● Daily “sedation interruption” and daily assessment of readiness to extubate. ● Daily oral care with chlorhexidine. ● Prophylaxis for peptic ulcer disease. ● Prophylaxis for deep venous thrombosis. 3 9
- 38. Contd ● Utilization ofendotracheal tubes with subglottic secretion drainage ● Initiation of safe enteral nutrition within 24-48 hours of ICU admission 4 0
- 39. Bundle for theprevention of surgical site infection (SSI) ● Administration of parenteral antibiotic prophylaxis. ● Patients should be washed with soap or an antiseptic agent within a night prior to surgery. ● Avoid hair removal: use electric clippers if necessary. ● Use alcohol-based disinfectant for skin preparation in the operating room. ● Maintain intraoperative glycemic control with target blood glucose levels < 200 mg/dL (in patients with and without diabetes) ● Maintain perioperative normothermia. ● Administer increased fraction of inspired oxygen during surgery and after extubation in the immediate postoperative period 4 1