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HOSPIAL ACQUIRED INFECTION
(DEPARTMENT OF COMMUNITY MEDICINE)



               Moderated by- Dr. Dhiraj Srivastava
               Presented by- Srihari Adhikari
                      Roll No.- 73
                      Batch- 2010
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) Source
2) Route of spread
3) recipients
1) SOURCE

• Patient

• Staff

• environment
2) Routes of spread
a) Direct contact
b) Droplet infection
c) Air borne particle
d) Release of hospital dust into the air
e) 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

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Hospital acquired infection

  • 1. HOSPIAL ACQUIRED INFECTION (DEPARTMENT OF COMMUNITY MEDICINE) Moderated by- Dr. Dhiraj Srivastava Presented by- Srihari Adhikari Roll No.- 73 Batch- 2010
  • 2.
  • 3. 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.
  • 4. • Word Nosocomial comes from the greek word nosokomeion meaning hospital (nosos= disease, komeo= to take care of)
  • 5. 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
  • 6.
  • 7. Surgical site infection • Any purulent discharge or abscess or spreading cellulitis at the surgical site during the month after the operation.
  • 8. Urinary infection • Positive urine culture (1 or 2 species) with at least 1o thousand bacteria/ml without clinical symptoms.
  • 9. 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.
  • 10. septicaemia • Fever or rigors and at least one positive blood culture
  • 11. Vascular catheter infection • Inflammation, lymphangitis or purulent discharge at the insertion site of the catheter
  • 12. Special situation that is usually HAI
  • 13. Infection in neonates that result from passage through birth canal
  • 14. Special situation that are not usually HAIs
  • 15. Complication or extension of infection(s) already present on admission unless a change in pathogen or symptoms strongly suggest the acquisition of new infection
  • 16. Infection in an infant that is known or proven to have been acquire transplacentally & become evident before 48 hour of birth
  • 17.
  • 18.
  • 19.
  • 20.
  • 21.
  • 23. 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
  • 24. 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%
  • 25. Hospital acquired infection can be considered from 3 angles 1) Source 2) Route of spread 3) recipients
  • 26. 1) SOURCE • Patient • Staff • environment
  • 27. 2) Routes of spread a) Direct contact b) Droplet infection c) Air borne particle d) Release of hospital dust into the air e) Through various hospital procedure
  • 30. c) Air borne particle
  • 31. d) Release of hospital dust into the air
  • 32. e) Through various hospital procedure like • catheterization • Intravenous procedure • dressing • infected cat gut • sputum cups • bed pans • urinals etc.
  • 33. 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
  • 35. 1) Isolation of infectious patient
  • 36. 2) Hospital staff • Keep away from work until completely cured
  • 38. 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.
  • 39. 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.
  • 40.
  • 41.
  • 42. 4) disinfection • Sterilization of instrument • Disinfection of article used by patient • Patients urine, faeces, sputum should be properly disinfected
  • 43. 5) Dust control • Suppression of dust by wet dusting & vacuum cleaning
  • 44. 6) Proper disposal of hospital waste
  • 45. 7) Control of droplet infection • Face mask • Proper bed lighting • ventilation
  • 46. 8) Nursing technique • Barrier nursing • Task nursing
  • 47. 9) Administrative measures • There should be hospital control of infection committee
  • 48. Hospital infection control committee • Medical superintendent- chairperson • Representative from major clinical departments. • Representative for nursing services. • CSSD in charge. • OT in charge. • Microbiologist.
  • 50. 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
  • 51. 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
  • 52. Role of central sterile supply department (CSSD) • CSSD is an accepted feature of hospital planning.
  • 53. 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
  • 54. 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.
  • 55. CSSD of our hospital
  • 56. • Manual steam sterilizer
  • 57. • Semi- automatic steam sterilizer
  • 67. 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