Control of nosocomial Infection in pediatricsControl of Nosocomial Infection in Paediatrics Shahnaz Armin, Shaheed BeheshteeUniversity, Iran A Webber Training Teleclass Hosted by Paul

ControlofNosocomialInfectioninPaediatricsShahnazArmin,ShaheedBeheshtee University,Iran

AWebberTrainingTeleclass

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ControlofnosocomialInfectioninpediatrics

SH.ArminAssociatedprofessorofShaheed

BeheshteeUniversity

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www.webbertraining.com July16,2019

Learningobjective

Whatisthenosocomialinfection/Healthcareassociatedinfection(HCAIs)?

WhatistheImpactofHCAIsonHealthsystem?

whataretheriskfactors?

Howtominimizetherisksofcontamination?

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Definition

Nosocomialinfectiondefinedbyexpertsas:

HCAIsareinfectionsthatarefirstappearin48hoursormoreafterhospitalizationorwithin30daysafterhavingreceivedhealthcareinpatientwhowasadmittedforaproblemlikelynotrelatedtothemicrobialpathogenandnotinincubationperiod.

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HAIs

devicerelatedsurgicalsiteinfections(SSIs)transmissible/infectiousdiseasesorpathogensofconcern(viral,bacterial,fungal,andMDRo)

donotdiscriminatebetweenage,gender,religion,orethnicity

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RateofNosocomial

inEurope,incidencesvaryfrom1%foralltypesofnosocomialinfectionsandupto23.6%inPICU.InUSAthetotalratearound4%.StudyfromSoutheastAsiancountriesreportedoverallprevalencerateof9.1%.Overally inhigh-incomecountriesHCAIsrateis5%–15%ofthehospitalizedpatients

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ImpactofHCAIs

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morbidity

mortality

cost

Hospitalstay

Abresistance



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ImpactofHCAIs

CDCcalculatedapproximately1.7millionnosocomialinfectionsfromalltypesofmicroorganismsresultingin99,000deathsannuallyinUSA.

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ImpactofHCAIs

StudyshowsthatseverelyimmunocompromisedhospitalizedpatientsareatthehighestriskofHAIs.

AmortalityrateduetoBSIinpediatricpopulationandneonateswere3%and11%,respectivelyespeciallyinverylow-birthweights

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ImpactofHCAIs

specializedprogramsneedtobedevelopedandtailoredtomeettheneedsofthepediatricpopulationbasedon:age-relatedfactorsthatpreventthechildfromadheringtoIP&CstandardsEffectofcaregiversonpreventionandtransmissionimmatureimmunesystemsDevelopmentalstage

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Generalriskfactor

closephysicalcontactwithhealth-careworkersstayinenvironmentswhereantibiotic-resistantorganismsareendemicStayinintensivecarewithindwellingdevicesHyperalimentationmechanicalventilationComorbiditiesneutropenicpatientstransplantation

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ChildrenarenotlittleadultTheyrefusetofollowisolationpercussionsChildlife- makingisolationfeelsolonelyNeedt5oplyroominhospital,whichchildisinfectiousinthereandcleanedisveryimportantChildismoreexposetohandonthanadultHandhygienedifficulttoreinforceforthemPPEmaynotfitoravailableforthem

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RiskfactorsforNI

• Theimmunologicalnaivetyofyoungchildren

• congenital/acquiredID• congenitalsyndromes• Closephysicalcontactbetween

childrenandvisitorsanduncontrolledfluidsandbodilysecretions

• Childrenaresusceptibletoinfectionsthatarepreventedinolderbyvaccinationorpreviousnaturalexposure

• Agemakevarietyincausativeorganisms

• chronicordegenerativeorgansystemdisorder

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HIGHRISKAREA

InfectionratesarethehighestinneonatalandPICU(wherebloodstreaminfectionsarethemostfrequent),andareusuallyassociatedwithintravasculardevices.Prematureinfantsmayhaveimmaturedefensemechanisms(includingskin,gastrointestinalsystems,lungsorbebornwithseveremedicalconditions

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Ongeneralpediatricwards:respiratoryandgastrointestinalinfectionspredominate

reflectingtheoccurrenceinthecommunity.

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pathophysiologyForthedevelopmentofaNI,twopathophysiologicfactorsmustbepresent:1-impairedhostdefenses2- colonizationbypathogenicornon-pathogenicbacteria

Mostnosocomialinfectionsarisefromtheendogenousbacterialfloraalthoughmanycriticallyillpatientseventuallybecomecolonizedwithresistantbacterialstrains.

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Chainofinfection

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Modeoftransmission

agent

source

Susceptiblehost

Portofentry



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Portalofentryintothehost

PortalofentryisthewaytheinfectiousagentcanenteranewhostCommonportalsofentryinclude:•Respiratorytract•Gastrointestinaltract•Mucosa(e.g.,conjunctiva,nose,mouth)•Genitourinarytract•Breachofskinintegrity

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Threetypesofinfectionaccountformorethan60%ofallnosocomialinfections:pneumonia(usuallyventilator-associated)urinarytractinfection(usuallycatheter-associated)primarybloodstreaminfection(usuallyassociatedwiththeuseofanintravasculardevice)

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Germsacquireways

person-personviahandsofhealth-careproviders,patientsandvisitorspersonalequipment(stethoscopes,personaldigitalassistants)andclothingairbornetransmission

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Modeoftransmission

Directtransmission

Indirecttransmission

Dropletinfection

Contactwithsoil

Inoculationintoskinormucosa

Vehicle-borne

Air-borne

Fomite-born

Uncleanhandsandfingers

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Humansourceofmicroorganismsthosewhoalreadyhaveadisease,orthosewhoareconsideredtobechroniccarriersofaninfectiousagent.

Patient

Visitor WorkerInfectioncontrol

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Modesoftransmission

Directcontact:consistofdirectbodysurfacetobodysurfacecontactandphysicaltransferofbacteriabetweenasusceptiblehostandaninfectedorcolonizedindividual.

Indirectcontact:involvescontactofasusceptiblehostwithacontaminatedobjectsuchasmedicalinstruments,dressings,glovesthatarenotchangedbetweenpatients.handhygiene

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Modesoftransmission

Droplet:distancefromthesource>1m,Infectiousdropletsaregeneratedduringcoughing,sneezing,talkingandthroughproceduressuchasbronchoscopyandsuctioning.Transmissionoccurswhenthesedropletsarepropelledashortdistancethroughtheairanddepositedonahost'smouth,nasalmucosaorconjunctivae.Wearasurgicalmaskwhileintheroom

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Dropletcontact

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Airborne:consistofdustparticlescontainingbacteriaorairbornedropletnucleiofevaporateddropletscontainingmicroorganismsthataresuspendedintheairforlongerdurationsoftime.Microorganismstransmittedinthismannercanbeinhaledbyasusceptiblehostventilationofthespace

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Strictpolicies

Educationofallcaregiversincreasetheadherenceandcompliancetopolicy

Monitoringcomplianceofhand,personalandenvironmentalhygiene

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educationandreinforcementrequiredtoensurepediatricsafety



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CentersforDiseaseControlandPrevention.CDCtwentyfourseven.SavingLives,ProtectingPeopleRecommendationsforApplicationofStandardPrecautionsfortheCareofAllPatientsinAllHealthcareSettings

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HANDHYGIENE

Inneonates,ongoingresearchfocuseson:reducingcontaminatingperiods(eg,lesshandlingofneonates)sequencingtypesofinfantcare(eg,movingfromcleantodirtysitesduringinfanthandling,Groupingonetypeofinfantcaretoonehandlingperiod

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Encourageotherstoparticipateininfectioncontrol

studentsmayroutinelyobservestaffwho:

failtowashhandsapplyinadequatetechniqueinhandwashingroutinelyviolatecorrectinfectioncontrolprocedures

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barrierstohandhygienecanbeovercomewhenrolemodelspromotingtheprocedureareclearlyidentifiededucationofthevisitortoensurethatheorshedoesn'ttransmitpathogenstohisorherchildortoother

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SusceptiblehostSeverelyimmunocompromisedchildrenrequireextraprotection:ventilationsystemsthatreducetheriskofexposuretofilamentousfungiTreatmentofunderlayingdiseaseImmunizationProphylacticantibiotictherapy

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Susceptiblehost,healthcareworker

AAP:Ø Healthcareworkersshouldreceivetheinfluenza

vaccineannually

Ø Whentransportingacontagiouspatient,facilitiesshouldcommunicateinformationaboutthepatient'sdiagnosisandisolation

Ø appropriatemanagementofinvasiveproceduresanddevices,sterilizationanddisinfectionofequipment,provisionofacleanenvironmentandadequatestaffing.

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StandardPersonalProtectiveEquipment(PPE)

IFdirectcontactwithblood&bodyfluids,secretions,excretions,mucousmembranes,non-intactskinGlovesPLUSgown

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Theappropriateuseofprophylacticantimicrobialstherapypreventssomenosocomialinfections,especiallyinhigh-riskpatients.

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Theimpactofinfectioncontrolonantimicrobialresistantinfections

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goals

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EffectiveIP&CProgram

forceful

Coverneedsofallagegroup

Supportedbyhigher

administration



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ContinueandSurveillance

Focuson:staffingnumbersandlevelsofexperienceearlydetectionandinterventioninoutbreaksituationsenvironmentalcontrols,adequatesuppliesprogramsforeducation.

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Noticetohighriskgroup:Immuno-deficientpatientsCancersTransplantscertainlungdiseasesimmaturity/VLBWnewborn

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ThefamilyisacorecomponentinpediatricwarditisimportanttorecognizeKnowledgeandcompliance ofthemasapotentialsourceforinfectionspread.

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goalofinfectioncontrolprograms

decreasetheincidenceofinfectionsinpatientsandstaffConsiderationsrelevanttoantimicrobialresistantorganisms

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Documents

Control of nosocomial Infection in pediatricsControl of Nosocomial Infection in Paediatrics Shahnaz Armin, Shaheed BeheshteeUniversity, Iran A Webber Training Teleclass Hosted by Paul