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HOSPITAL ASSOCIATED Infections

overcoming emerging challenge Dr.T.V.Rao MD

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Aim of Infection Prevention • The aim of the Infection

Prevention and Control Service is to promote as safe an environment as possible for staff, patients and visitors, in order that the risk of healthcare associated infections are kept to a minimum.

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What matters Infection to patients and many around

• For most patients and their families, the process of healthcare appears to be a simple one. Patients are admitted to the facility and a specific course of treatment and care is carried out by physicians, nurses, and technicians• It is the beginning of many

matters and infection is a great preventable factor

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Never forget the safety of the Patients is interdisciplinary

factor • Every healthcare facility uses

interdisciplinary task forces such as the Safety Committee and the Infection Control Committee to minimize patient and employee risk. Although its existence may not be widely recognized by patients, the Infection Control Committee plays an integral part in the care of every patient.

Objectives of Infection Control Understand basic infection control (IC) conceptsUnderstand the causes of nosocomial infectionsUnderstand the components of an infection

control programUnderstand how the Infection Control

Committee and DTC can decrease the incidence of nosocomial infections and antimicrobial resistance (AMR)

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Introduction—Why Infection Control?

• Hospital acquired infections are a common problem—prevalence about 9%• Hospital acquired infections contribute to AMR • Overuse of antimicrobials (development)• Poor infection control practices (spread) • Hospital-acquired infections increase the cost of health care• World Bank studies have shown that two-thirds of developing countries spend

more than 50% of their health care budgets on hospitals• Effective IC programs are beneficial• They decrease spread of nosocomial infections, morbidity, mortality, and

health care costs

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Why Is the Infection Control Committee Important?

• Everyone knows that infection control is the responsibility of all healthcare workers. Patients and employees are only safe from infectious processes when everyone follows good infection control techniques

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Why Is the Infection Control Committee Important?

• The purpose of the Infection Control Committee is not to reduce the individual responsibility that each healthcare provider has, but to provide leadership for all employees throughout the facility. Through policies, procedures, and evaluation processes, the committee acts as a central clearing house for all infection control information and channels that information in a manner that will create the safest healthcare environment.

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Why Is the Infection Control Committee Important?

• It also helps to standardize infection control procedures throughout the facility so that the same level of care is provided in all departments. This standardization helps to control and maintain the facility's environment and ensures that patients receive the same level of infection control in all areas. For example, the Infection Control Committee may take steps to ensure that the standard for instruments used in invasive procedures performed outside of the OR is the same as invasive procedures performed .

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What is Infection Control • Infection Control—The

process by which health care facilities develop and implement specific policies and procedures to prevent the spread of infections among health care staff and patients

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Nosocomial Infection •Nosocomial Infection—An infection contracted by a patient or staff member while in a hospital or health care facility (and not present or incubating on admission)

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Terms we should be Familiar

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Disinfection •Disinfection—The

process of microbial inactivation that eliminates virtually all recognized pathogenic microorganisms, but not necessarily all microbial forms (e.g., spores)

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Sterilization• Sterilization—The use of physical

or chemical procedures to destroy all microbial life, including large numbers of highly resistant bacterial endospores. Procedures include— • Steam sterilization• Heat sterilization• Chemical sterilization

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Root Causes of Nosocomial Infections

Lack of training in basic IC

Lack of an IC infrastructure and poor IC practices (procedures)

Inadequate facilities and techniques for hand hygiene

Lack of isolation precautions and procedures

Epidemiology of Nosocomial Infections

Most common sites for nosocomial infectionsSurgical incisionsUrinary tract (i.e.,

catheter-related)Lower respiratory tractBloodstream (i.e.,

catheter-related)

Epidemiology of Nosocomial Infections

Common microorganismsAerobic gram-positive

cocci (Staphylococcus aureas [MRSA], enterococci [vancomycin-resistant]),

Aerobic gram-negative bacilli (Escherichia coli, P. aeruginosa, Enterobacter spp., and Klebsiella pneumoniae)

Epidemiology of Nosocomial Infections (3)

Nosocomial transmission of community

acquired, multidrug-resistant organismsM. tuberculosisSalmonella spp.Shigella spp.V. cholerae

Root Causes of Nosocomial Infections

Lack of training in basic IC

Lack of an IC infrastructure and poor IC practices (procedures)

Inadequate facilities and techniques for hand hygiene

Lack of isolation precautions and procedures

Root Causes of Nosocomial Infections (2)

Use of advanced and complex treatments without adequate training and supporting infrastructure, including—

Invasive devices and procedures Complex surgical procedures Interventional obstetric practices Intravenous catheters, fluids, and

medications Urinary catheters Mechanical ventilators Inadequate sterilization and disinfection

practices and inadequate cleaning of hospital

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Root Causes of Nosocomial Infections

Use of advanced and complex treatments without adequate training and supporting infrastructure, including— Invasive devices and procedures Complex surgical procedures Interventional obstetric practices Intravenous catheters, fluids, and medications Urinary catheters Mechanical ventilators

Inadequate sterilization and disinfection practices and inadequate cleaning of hospital

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Who Serves on the Infection Control Committee?

•The Infection Control Committee is generally comprised of members from a variety of disciplines within the healthcare facility. Representation may include: physicians, nursing staff, infection control practitioners, quality assurance personnel, risk management personnel as well as representatives from microbiology, surgery, central sterilization, environmental services, etc.

Infection Control Committee (1)Membership— Doctors

General physician Infectious disease specialist Surgeon Clinical microbiologist

Infection control nurse Representatives from other relevant

departments Laboratory Housekeeping Pharmacy and central supply Administration

Infection Control Committee Goal— To prevent the spread of infections

within the health care facility Functions— Addressing food handling, laundry

handling, cleaning procedures, visitation policies, and direct patient care practices

Obtaining and managing critical bacteriological data and information, including surveillance data

Infection Control Committee Functions (cont)Developing and

recommending policies and procedures pertaining to infection control

Recognizing and investigating outbreaks of infections in the hospital and community

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Infection Control Committee • Intervening directly to prevent infections•Educating and training health care workers, patients, and nonmedical caregivers

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The Purpose of the Team is to find solutions

• The goal of this interdisciplinary team is to bring together individuals with expertise in different areas of healthcare. By creating a diverse group, issues can be addressed from several angles, and members can pool their expertise to develop the best solutions possible.

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What Does the Infection Control Committee Do?

•The role of the Infection Control Committee is very multi-faceted. It should be involved in planning, monitoring, evaluating, updating, and educating

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What Does the Infection Control Committee Do?

• It sets general infection control policy and provides input into specific infection control issues. Simply stated, its function is to prevent and control nosocomial infections.

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What Does the Infection Control Committee Do?

• . That is accomplished in a variety of ways some of which include: surveillance of nosocomial infections, product evaluation, investigation of infection outbreaks and infection clusters, development of infection control procedures for all departments, staff and patient education, medical waste management, etc

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How Does the Infection Control Committee Prevent

and Control Infection?

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Planning• Successful prevention and control

of infection requires careful planning. The Infection Control Committee is actively involved with the planning and implementation of new procedures that pose a potential infection control risk. For example, it may provide guidance for the set-up of an endoscopy lab or the implementation of a new procedure

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Planning• Its role in the planning

process is to examine the proposal, identify potential areas of concern, and recommend a course of action that provides the best method of infection control.

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Committee Decides on the Chemical and Disinfectants

we use in the Hospitals • The committee also may provide input into the

selection of chemicals used to manage the environment, such as detergents and disinfectants. It may also provide input into the selection of equipment used to process instruments and accessories. The multidisciplinary composition of the committee makes it an ideal place to examine new product and procedure proposals from several aspects.

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Monitoring• The Infection Control Committee

also monitors infectious processes within the healthcare facility. They track nosocomial infections and incidents that have the potential to cause infections. They review infection control statistics from the facility in an effort to minimize risk, identify problem areas, and implement corrective actions.

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Monitoring•When infections do

occur, the committee undertakes epidemiological investigations to determine the cause of the problem and recommends the necessary education or changes in protocols.

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Evaluating• Along with monitoring specific

incidents, the Infection Control Committee also looks at the bigger picture as it continually strives to improve processes within the facility. This is demonstrated by the regular review of infection control procedures for all departments. The committee may also be called upon to evaluate practices and provide input regarding products and protocols.

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Updating• Perhaps one of the biggest

challenges that all Infection Control Committees face is keeping current. The constant advancement of medical technology introduces changes at all levels within the healthcare facility, new bacterial strains complicate and challenge older infection control practices, and new research often requires re-examination of established procedures

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Updating• The Infection Control

Committee's purpose is to provide guidance and leadership through these changes. This requires that all members of the team strive to keep abreast of changes within their area of expertise. By keeping current, they can assist the committee as it works to manage its facility's infection control policy

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Educating• Finally, as an integral part of its

leadership, the committee must take an active role in staff education. That role may be a hands-on approach or it may be an advisory role in partnership with the facility's education department. However it functions, the committee must set direction for staff education and validation of that education.

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Responsibilities: • 1. Advice staff on all aspects of

infection control and maintain a safe environment for patients and staff 2. Provide educational programmes on the prevention of hospital infection for all hospital personnel 3. Provide a basic manual of policies and procedures and ensure that local written guidelines based on these are in existence

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Responsibilities: • Establish systems of surveillance

of hospital infection in order to identify at-risk patients and problem areas that need intervention. Methods for surveillance may include case findings by ward rounds and chart reviews, reviews of laboratory reports, and targeted prevalence of incidence survey

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Responsibilities: • Advise management of

patients requiring special isolation and control measures 6. Investigate and control outbreaks of infection in collaboration with medical and nursing staff . Ensure that an antibiotic policy is in existence

Isolation and Standard PrecautionsWhenever possible, avoid crowding wards. Implement specific policies and procedures for patients

with communicable diseases:Private rooms and wards for patients with specific

diseasesVisitation policies Hand washing and use of gloves Gowns, when appropriateMasks, eye protection, gownsPrecautions with sharp instruments and needles

Ensuring a Clean Environment Establish policies and procedures to prevent food and water

contamination Establish a regular schedule of hospital cleaning with appropriate

disinfectants in, for example, wards, operating theaters, and laundry

Dispose of medical waste safely Needles and syringes should be incinerated Other infected waste can be incinerated or autoclaved for landfill disposal

Bag and isolate soiled linen from normal hospital traffic

Universal Precautions•Precautions that protect the patient/client, co-workers, and community from infection•Universal Precautions

Universal Precautions•Universal Precautions

Techniques•Wear gloves when• touching blood• touching mucous

membranes• performing venipuncture• touching body fluids of any

kind

Practice Universal Precautions with Body fluids • Body Fluids• vaginal fluids or semen• cerebrospinal fluid• pleural fluid (fluid around lung)• pericardial fluid (fluid around

heart)• synovial fluid (fluid in the joints)• amniotic fluid (fluid around the

fetus)• placenta tissue• saliva with blood in it

Isolation Precautions• Isolation• condition of having limited

contact with others• Protective Isolation• guarding workers and visitors

from danger• Reverse Isolation• guarding the patient from

danger

Types of Isolation•Respiratory Isolation•protection from

airborne droplets•Skin and wound Isolation•protection from open

wounds, skin drainage

Types of Isolation•Enteric Isolation•solid body wastes

•Strict Isolation•complete protection

•Blood and body fluids

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Responsibilities: • Coordinate with the

hospital doctors and administration (managerial and nursing), community health doctors and nurses and infection control staff in adjacent hospitals

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Hand Washing – a Great Idea to control and prevent

Infections• Hand Hygiene is of

paramount important to the Trust and we have trained designated Hand Hygiene Champions in every clinical area who promote the World Health Organisation’s (WHO) 5-Moments of Hand Hygiene standards

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Hand Hygiene • Handwashing is one of the

most effective measures of reducing infection and all staff and visitors are asked to wash their hands or use the alcohol hand foam l before and after seeing relatives or patients. These facilities are available throughout our hospitals.

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If you have washed your hands you have contributed your best in reduction of

Nosocomial Infections

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Infection Control ResourcesInfection control manuals, protocols, and training programs (See Participants’ Guide, annex 1)CDC website—protocolsEngender Health training program—web-based

training for basic infection programsICAT—tool that can be used in low-resource

countries to improve infection control practices (can be obtained from RPM Plus/MSH)

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References • The Infection Control Committee Farrah Lee, BSN, and Natalie Lind,

ACE Infection control today • CDC guidelines

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