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basic details about hospital acquired infection........
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HOSPIAL ACQUIRED INFECTION (DEPARTMENT OF COMMUNITY MEDICINE)
Moderated by- Dr. Dhiraj SrivastavaPresented by- Srihari Adhikari
Roll No.- 73Batch- 2010
U.P. RURAL INSTITUTE OF MEDICAL SCIENCES AND
RESEARCH
Definition• Hospital acquired infection / nosocomial
infection are infection acquired during hospital care which are not present or incubating at admission.
• Infection occurring more than 48 hours after admission are usually considered nosocomial.
• Word Nosocomial comes from the greek word nosokomeion meaning hospital (nosos= disease, komeo= to take care of)
Definition by CDC
• Infection that patients acquire during the course of receiving treatment for other conditions or that health workers acquire while performing their duties within healthcare setting
Surgical site infection
• Any purulent discharge or abscess or spreading cellulitis at the surgical site during the month after the operation.
Urinary infection
• Positive urine culture (1 or 2 species) with at least 1o thousand bacteria/ml without clinical symptoms.
Respiratory infection
Respiratory symptoms with at least 2 of the following signs appearing during hospitalization
• Cough• Purulent sputum• New infiltrate on chest
radiograph consistent with infection.
septicaemia
• Fever or rigors and at least one positive blood culture
Vascular catheter infection
• Inflammation, lymphangitis or purulent discharge at the insertion site of the catheter
Special situation that is usually HAI
Infection in neonates that
result from passage
through birth canal
Special situation that are not usually HAIs
Complication or extension of infection(s)
already present on admission unless a change in pathogen
or symptoms strongly suggest
the acquisition of new infection
Infection in an infant that is
known or proven to have been
acquire transplacentally & become evident
before 48 hour of birth
Researches in India
Prospective study in burn unit of a tertiary case referral centre in north india
• Hospital wide study is Performed by Taneja N., Emmanuel R.,Chari P S, Sharma M. in 2004
• 71 patient developed 59 hospital acquired infection.
• Infection density- 36.2 infection per 1000 patient day
• Commonest- invasive wound infection
U.T.I. study in JNMC Aligarh
• Performed by M. Akram, M.Shahid, A U Khan in 2007.
• 100 sample infected out of 920 tested urine sample.
• Infection of E. Coli- 61%Klebsiella – 22%
Hospital acquired infection can be considered from 3 angles
1) Source2) Route of spread 3) recipients
1) SOURCE
• Patient
• Staff
• environment
2) Routes of spread
a) Direct contact b) Droplet infectionc) Air borne particled) Release of hospital dust into the aire) Through various hospital procedure
a) Direct contact
b) Droplet infection
c) Air borne particle
d) Release of hospital dust into
the air
e) Through various hospital procedure like
• catheterization• Intravenous
procedure • dressing • infected cat gut • sputum cups• bed pans• urinals etc.
3) RECIPIENTS
a) Patient especially severely ill & under corticosteroid therapy
b) Cross infection is greater in• Intensive care unit• Urological ward• Geriatric ward• Special baby care unit
PREVENTIVE MEASURES
1) Isolation of infectious patient
2) Hospital staff
• Keep away from work until completely cured
3) Hand washing
WHO guideline for hand hygiene in health care
• Washing hand with soap & water
• Preferably use an alcohol based hand rub for routine hand antisepsis
• When alcohol based hand rub is already used do not used antimicrobial soap concomitantly.
Perform hand hygiene
• Before & after having direct contact with patients• Before handling an invasive device for patient care
regardless of whether or not gloves are used• After contact with body fluid or excretion , mucus
membrane, non intact skin, or wound dressing.• If moving from a contaminated body site to a clean
body site during patient care.• After contact with inanimate objects (including
medical equipment) in the immediate vicinity of the patient.
4) disinfection• Sterilization of instrument• Disinfection of article used by patient• Patients urine, faeces, sputum should be
properly disinfected
5) Dust control
• Suppression of dust by wet dusting & vacuum cleaning
6) Proper disposal of hospital waste
7) Control of droplet infection
• Face mask• Proper bed
lighting• ventilation
8) Nursing technique
• Barrier nursing
• Task nursing
9) Administrative measures
• There should be hospital control of infection committee
Hospital infection control committee
• Medical superintendent- chairperson• Representative from major clinical
departments.• Representative for nursing services.• CSSD in charge.• OT in charge.• Microbiologist.
Standard to be maintained in hospital
An attempt should be made to achieve and maintain an average
count of 10-15 bacteria/cubic foot of air in hospital
less than 5 bacteria/ cubic foot- minimal risk of infection
more than 35 bacteria/ cubic foot of air- heightened risk
Guideline to evaluate the floor cleaning procedure
Based on rodac plate count
• 0-25 bacteria/cubic foot- good floor cleaning procedure
• 26-50 bacteria/cubic foot- satisfactory• More than 50 bacteria/cubic foot- not
satisfactory
Role of central sterile supply department (CSSD)
• CSSD is an accepted feature of hospital planning.
Function of CSSD
• Supply of sterile instrument & material for dressing & procedure carried out in wards & department.
• Sterilization of instrument & linen for use in operation theatre
CSSD also look after
• Disinfection & sterilization of medical equipment such as ventilators, baby incubators, oxygen tents etc.
• Selection & distribution of single use (disposable) sterile supplies such as catheters, suction tubing & syringe.
CSSD of our hospital
• Manual steam sterilizer
• Semi-automatic steam sterilizer
Automatic steam sterilizer
ETO (ethylene trioxide) sterilizer
Washer disinfector
Ultrasonic cleaner
Gloves unit in CSSD
Glove washer
Glove dryer
Glove testing machine
Glove powdering machine
References• Park’s textbook of Preventive & social medicine• Harrisons principle of internal medicine• Textbook of microbiology: Ananthnarayana• Bennett & Brachmans hospital acquired infection:
William R. Jarvis• Hospital administration: Francis & De Souza• www.burnsjournal.com date 09-07-2012• www.ann-clinmicrob.com date 09-07-2012• www.jornalofhospitalinfection.com date 09-07-
2012• CSSD of UP RIMS&R Saifai, Etawah
THANK YOU