Health Care Associated Infections and Infection Control

Terminology

•Health Care Associated Infections – HCAIs

•Hospital Acquired Infections – HAIs•Throughout history drastic decreases in

mortality and morbidity have been made through advances in hygiene.

•There still an awful lot of work to do.

It is quite a problem.

•HAIs are the most common hospital complication.

•Costs and issues:▫Morbidity and mortality▫Increase in hospital stay▫Cost of antimicrobial therapy▫Reduced productivity▫Insurance claims▫Additional reservoir for the infection

Statistics• 200,000 HAIs leading to 7000 deaths (2003).• $268 million per year for surgical site infection

(2003).• $686 million per year for blood stream

infections (2003).• 2 million bed days per anum (2003).• You’ll notice these are widely different to those

in the summary. We’ve improved.• Most common HAIs

▫UTIs, surgical wounds, lower respiratory tract, skin, blood

Causes

•What bacteria have been responsible for HAIs have changed over the years.

•Many infections are now due to resistant bacteria.

•MRSA, VREF, ESBL, CDAD, VRSA, VISA etc

•Viruses – norovirus, rotavirus, cytomegalovirus, herpes simplex, RSV

•Fungi – candida, aspergillus funigaus

Staph

•MRSA is endemic in many hospitals. •Strains with decreased sensitivity to

vancomycin have been identified.▫Lead us to VISA (vancomycin intermediate

staph.)•Staph. Epidermidis

▫Many infections associated with IV lines, shunts, prosthetics.

▫Resistant strains are now common.

VRE

•Vancomycin resistant enterococci•Enterococci is already naturally resistant

to a lot of drugs, leaving vancomycin as the only treatment available.

• Incidence of infection is low, colonisation is common.

•Exposure to broad spectrum antibiotics predisposes a person to infection.

•VRE may transfer resistant to MRSA via plasmids.

CDAD

•Clostridium difficle associated diarrhoea.•Most common cause of hospital acquired

diarrhoea.•Exposure to broad spectrum antibiotics

predisposes a person to infection.•Common in the immunocomprimised.•Produces different to remove spores.•Resistant to clindamycin and quinolones

Sources of infection

Identifying Infection

•Swab everywhere and anywhere.•Blood collection

▫Two sets different routes, some time period apart (30 minutes)

▫Each set used for anaerobic and aerobic cultures.

▫Be wary of contamination.

Stopping Infection

Australian Infection Control Guidelines

• Australian Guidelines for the Prevention and Control of Infection in Healthcare (2010)

• Nationally accepted approach to infection control.• Should be read by every healthcare worker.• Guidelines cover

▫Understanding of modes of transmission of risk management

▫Effective work practices that minimise the risk of transmission

▫Governance structures to monitor and regulate▫Compliance with legislation