HAI and new technologies that may contribute to the reduction of nosocomial infections

1. InfectionControl: An overview
Prof. Dr. Abdelraouf A. Elmanama
Medical Laboratory Sciences Department
Islamic University-Gaza
2020

2. HAIis Definedas
• Any“new” infection that isnot present or incubatingat the
time thepatient isadmitted to theHealth care institution.

3. Other names forHealth Care Associated infections
• Health CareAssociatedinfections(HAI)
Used to be referred to as:
• HospitalAcquiredinfection
• Nosocomialinfection.

4. Reasons for rising infections inhospitals
1. Advancing age of the patients, asthey are
more prone to infection.
2. Use of sophisticated andcomplicated
equipment which isnot easy to clean,
disinfect or sterilize.
3. Increasing specialization bringing together
patients susceptible to some type of
infection.
4. Increased use of antibiotics resulting in
drug resistance.
5. Higher rate of staff turnover makes it
difficult to maintainuniform standards

5. Consequences ofHospital AcquiredInfections
• Increasedmorbidity
• Prolongedhospitalization
• Long-term physical, developmental and neurological
sequelae
• Increasedcost of hospitalization
• Death

6. HAI is the concern of every one.Why?
See the numbers!!!!
• TheCenters for DiseaseControl(CDC)
estimates that 2 million U.S. patientsa year
acquireHAI.

7. InfectionControl
• Infectioncontrol is thediscipline concerned with preventing
healthcare-associatedinfection. (other infectionsalso may be
included).
• It is a practical (rather thanan academic) sub-discipline of
epidemiology.
• It is an essentialpart of the infrastructureof healthcare.

8. The complextask
• Infection control addresses factors related to the spread of infections
within the health-caresetting
• Patient-to-patient,
• Patientsto staff
• From stafftopatients,
• Among-staff
including prevention (via hand hygiene/hand washing, cleaning/
disinfection/ sterilization, vaccination, surveillance),
monitoring/investigation of demonstrated or suspected spread of infection
within a particular health-caresetting (surveillance and outbreak
investigation), and management (interruption of outbreaks).

10. Beginningof Hospital InfectionProgramme
• Modern hospital infectioncontrol programs first began in the
1950s in England, wheretheprimary focus of these programs
was to prevent and control hospital-acquired staphylococcal
outbreaks.
• In 1968, theAmerican Hospital Association published
"Infection Control in the Hospital,"

11. FirstData on Infection Control Efficacy
• Datacollected in 1970 and 1976-1977 suggested thatone-
third of allnosocomialinfectionscould be prevented
• In 1985, theStudy of theEfficacy of Nosocomial Infection
Control (SENIC) project was published, validatingthe cost-
benefitof infectioncontrol programs.

12. Risk Assessment of Substancesin Use for ICP
• Varioussubstancessuchas disinfectantsusedtopreventcrossinfectionare
subjecttorisk assessmentpriortouse.
• Theprocessinvolve:
• Identifytherisk
• Assesstherisk
• Notecurrentmeasureswhichare beingusedtocontrolor mitigatetherisk
• Inform/trainstaff
• Monitoroutcomes
• Implementpoliciesandprocedures

13. What weneed and what to do?
• One infectioncontrol professional (ICP) for every 250
beds.
• An effective infectioncontrol physician.
• A program reporting infectionrates back to the surgeon
and those clinicallyinvolved with the infection.
• Anorganized hospital-widesurveillancesystem.

14. InfectionControl Challengesof Healthcare inthe 21th
century
• Decreasingfunds.
• Increasingemerging infections.
• Increasingresistantorganisms.
• Increasingdrugcosts.
• Reporting-healthcare-associatedinfections(difficultiesandobstacles)
• Nursingshortage
• Safetylegislation
• Lackor multiple benchmarksystems

15. Infection control was influencedby the reform
of theHealthcare System
• Infectioncontrol programs hadtoencompass not only hospitals
but also:
• Thelong-termcarefacility
• Homehealth/hospice
• Rehabilitationfacilities
• Free-standingsurgicalcenters
• Physician officepractices

16. ChangingDemands on InfectionControl programme
Today's ICP needsknowledgeof
• Epidemiologystatistics,
• Patientcarepractices,
• Occupationalhealth,
• Sterilization,disinfection,and sanitation,infectiousdiseases,
• Microbiology,
• Education
• Management

17. Infection Control CommitteeandAntibiotic Policies are the
Backbone for reduction of Infections

18. MajorResponsibilitiesof I C P
• Surveillance,
• Specificenvironmental monitoring,
• Continuous quality improvement,
• Consultation,
• Committee involvement,
• Outbreak and isolation management,
• Regulatory compliance and education.

19. MajorResponsibilitiesof I C P
• To plan,coordinate, and succeed in fulfillingthese responsibilities,
many ICPs have to redefine their roles.
• More ICPs are becoming managers by creating multidisciplinary
support teams to carry out many of the functions.

20. GUIDELINES AND RECOMMENDATIONS
• HandwashingandHospital EnvironmentalControl
• Immunization
• InfectiousDiseases Control
• IntravascularDevice-RelatedInfectionsandits control
• IsolationPrecautions

21. Scientific(proper)DisinfectionPractices
Saves Lives
• * Hospital Construction
• * Sterilization / Disinfection

22. Surveillance
• The key to ongoingmonitoringis surveillance for
HAI.
• Various techniques for surveillance have been
described and evaluated including
• Total house surveillance
• Targeted surveillance
• Laboratory-based

23. Computerized Surveillance
• Surveillance traditionally involvedsignificant
manual data assessment.
• Increasingly,integrated computerizedsoftware
solutionsare becomingavailable that assess
incomingrisk messages from microbiologyand
other onlinesources.

24. Outbreak Investigations
• Unlike scheduled activities,occasionalclusters of
patientswhoare colonizedorinfected will trigger
further investigationincludinga case-controlstudy.
• Newlaboratorymethodsdevelopedand refined within
thelastdecadecannowdetermine howrelatedthe
strain isatthemolecular level.

25. InfectionControl Programme Integrated withHealth
Authorities
• The institutionusuallymakes theinfectioncontrol program
responsible for reporting communicablediseases required by
statelaw.
• ICPs need to plan on interactingwithlocal and statehealth
departmentsregarding exposure thatmay needimmediate
communityfollow-up (e.g., tuberculosis,Cholera).
• ICPs shouldassist the healthdepartment inconfirming
cases that may have been seen inthe hospital or clinic.

26. Formulating an InfectionControl Plan
• Every infection control program should develop a well-defined written
plan outlining the organizational philosophy regarding infection
prevention and control.
• The plan should take into account the goals, mission statement, and an
assessment of the infection control program.
• It should include a statement of authority, and should review patient
demographics including geographic locations of patients served by the
healthcare system

27. Staff Training in ICP
• Education programsforemployeesandvolunteersare
one method to ensure competent infection control
practices.
• It isa unique challenge since employeesrepresent a
wide rangeof expertise and educational background.
• The ICP must become knowledgeable in adult
education principles and use educational tools and
techniques that willmotivate and sustain behavioral
change.

28. InfectionControl Programme and Documentation
• Goalsof the infectioncontrolprogram need to be
incorporatedinto the missionstatement of the facility.
• A missionstatementshouldtellwho you are, what you
do, andshouldcommunicatea clearview of purpose
andset a strategy for accomplishingthe goal

29. Document AntibiogramsWith WHONET
• WHONET is a free Windows-based
database software developed for the
management and analysisof
microbiology laboratory data with a
special focus on the analysisof
antimicrobial susceptibility test results.

30. CDC Guidesthe MedicalprofessionICP
• CDCwiththeHospitalInfectionControlPracticesAdvisoryCommittee
(HICPAC)hasproducedor revisedseveral major guidelinesinthepasttwo
yearsincluding,
• GuidelinesforInfectionControlinHealthcarePersonnel,andGuidelinesfor
ManagementofHealthcareWorkerExposurestoHIV and
RecommendationsforPostexposureProphylaxis,GuidelinesforPrevention
ofSurgicalSiteInfections.
• APIChasdevelopedseveral guidelinescoveringtopicsincludingantisepsis
andhandwashing,disinfectionandsterilization,endoscopy,andlong-term
care.

31. Health Care Means In patient careand outpatient
care
• Significanttrends in healthcare are occurring
everyday includingnew medical procedures (i.e.,
genetherapy), new technology(multi-purpose
intravenous catheters), anda shift from inpatient
to outpatient care.

32. New technologiesandhospital infectioncontrol

33. Light technology to combat Hospital Infections
• A pioneeringlightingsystem thatcan killhospitalsuperbugs
– includingMRSAand C.diff– has been developed by
researchers at theUniversity of Strathclydein Glasgow,
Scotland.
• The technologydecontaminatesthe air and exposed surfaces
by bathingthem in a narrow spectrum of visible-light
wavelengths, knownas HINS-light. (high-intensitynarrow-
spectrum )

34. Light technology to combat hospital infections
• Clinical trials at Glasgow Royal Infirmaryhave shown that
the HINS-lightEnvironmentalDecontaminationSystem
provides significantlygreater reductions of bacterial
pathogensin thehospital environmentthancan be achieved
by cleaningand disinfectionalone, providing a hugestep
forward in hospitals'ability to prevent the spread of infection.

35. 35
Light Technology to Combat Hospital Infections
• HINS-lightisa safetreatment thatcanbe
easilyautomatedtoprovidecontinuous
disinfectionofwards andotherareas ofthe
clinicalenvironment.
• Thepervasivenatureoflightpermitsthe
treatmentofair andallvisiblesurfaces,
regardlessofaccessibility,eitherthrough
director reflectedexposuretoHINS-light
withinthetreatedenvironment

36. 36
Medical Dressing Uses Nanotechnology to Fight Infection
• Scientists at the University of Bath and the
burns team at the Southwest UK Pediatric
Burns Centre at Frenchay Hospital in Bristol
are working together with teams across
Europe and Australia to create anadvanced
wound dressing.

37. • The dressing willwork by releasing antibioticsfrom
nanocapsules triggered by thepresence of disease-causing
pathogenicbacteria, whichwill target treatmentbefore the
infectiontakeshold.
• The dressing willalso change colour whenthe antibioticis
released, alertinghealthcareprofessionals thatthere is
infectionin thewound.

38. 38
Bandages Change Color IfInfectionsArise
• The dressing will work by releasing
antibiotics from Nano capsules triggered
by the presence of disease-causing
pathogenic bacteria, which will target
treatment before the infection takes hold.
• Change in color is based on changes of pH of the
skin
http://www.upworthy.com/a-color-changing-
bandage-may-just-change-how-we-treat-
infections

39. 39
New Nanotechnology forHospital Infection Control Receives FDA Approval
(Antimicrobial Surfaces)
• SilvaGard can be used to treat virtually any
medical device and its use does notalter the
device'soriginal properties.
• Due to these and other unique attributes,
SilvaGard is expected to have a significant impact
on the battle against hospital-related infections.
http://www.nanotechproject.org/inventories/medicine/ap
ps/medical_tools/silvagard_technology/

40. 40

41. 41
Long Sleeves x Short Sleeves
• Results froma studyby Denver Health andUniversityof
ColoradoHealthServices Center researchersshowedthere were
nostatistically significantdifferences foundinbacterial orMRSA
counts betweenphysicians’ coats and newlylaunderedshort-
sleeveduniforms.
• The researchers’findings sheds new lightonBritishgovernment
agencies’ policies banning physicians’ whitecoats basedon the
beliefthat longsleeves carrymore bacteriaand pose a greater
riskofbacterialtransmission

42. 42
Vision-based hand gesture recognition Technology
• Thetechnology relies on hand gestures as commands,
which can control robotic nurses or tell computers to
display pertinent patient health information.
• Thevision-based hand gesture recognition technology
couldreducethe need for touching equipment.

43. 43
Involvementof PhysiciansMore Important
Physicians to be more involvedand lead quality improvement
efforts in their respective healthcaresettings.
Drs. Pronovostand Marsteller suggest that even though quality
improvement efforts exist, there is notenough data supporting
the notion that quality improvement efforts are actually
enhancing patient outcomes.
Oneof the reasons for this lack of progress, they say, is
inadequate physician engagement and leadership in quality
improvement work.
Peter Pronovost, MD,PhD,andJill Marsteller, PhD,MP

44. 44
ScientificDocumentation Reduces Hospital Infections
( January20,2011)
• Researchers evaluated the effect of an Electronic
Medical Record on the use of antimicrobial agents
and infectionrates of Clostridiumdifficileand MRSA.
• Results showed that implementation of an EMR
significantly increased chart reviews and antimicrobial
recommendations, leading to a decrease in antimicrobial
useand MRSAas wellas C.difficileinfectionrates.

45. Impactof Hand Washing on Influenza
• Health experts believe a flu epidemic wasaverted
because ofregularhand-washing, suggesting
healthcare facilitiesshould promotehand-
washing among staffand patients topreventthe
spreadofdisease.
• The American Societyfor Microbiologyandthe
AmericanCleaning Institute releaseda studyin
Sept. 2010 reportingthat 85% ofpeople washed
theirhands in public restroomsin 2008, the
highest levels observed since the researchbegan
in1996.
45

46. 46
HandHygiene Compliance
• Researchers have implemented a hand hygiene program driven by a
behavioral changeapproach to increase hand hygiene compliance.
• Thehand hygiene program was packaged with several initiatives. It included
access to alcohol sanitizer, education as well as ongoing audit and feedback.
• Theprogram was also supplemented with behavior modification practices,
such as immediate positive reinforcement as well as annually changing
incentives.
• Theresearchers report the program has resulted in significant and sustained
improvements in hand hygiene compliance.

47. 47
Which Skin Preparation Agent is Superior?
• Researchers conducted a review of surgical skin prep agents to conclude which agentwas
most cost-effective and superior in preventing surgical site infections.
• Based on information collected from two databases, researchers compared povidone-iodine,
Chlorhexidine gluconate, parachoroxylenol and iodine povacrylex (0.7 percent available
iodine) in 74 percent isopropyl alcohol (DuraPrep).

48. 48
Yet… No IdealChemical Agent
• Researchers concludedthat eachagent has specific
advantages and disadvantages and noone skin prep agent
is superior in all clinical situations.
• Factors toconsiderwhen choosing a skin prep agent include
surgeon preference and environmental risks.

49. What can be done
Or
Should be done
Or
We think it must/may be done

50. • Healthcare workersmaybeexposedtocertaininfectionsinthecourseof
their work.
• Vaccinesare availabletoprovidesomeprotectiontoworkers ina healthcare
setting.
• Dependingonregulation,recommendation,thespecificwork function,or
personalpreference,healthcare workersor firstrespondersmay receive
vaccinationsforhepatitisB;influenzameasles,mumpsandrubella;
Tetanus,diphtheria,pertussis;N.meningitides;andvaricella.
• TheproblemofresourcesforprovingVaccinesinDevelopingcountries
continuestobereal problem,needadditionaleconomicresources
Health Care Workersare at Risk –Need for Vaccination

51. Become aMemberof Alliance for the Prudent Use of Antibiotics (APUA)
www.apua.org
• An internationalorganizationdedicated
tocombatantibioticresistance
• Chaptersexistcurrently in several
countries:

52. 52
Train EveryOne
• This is thesinglemostimportantfactor
in thecontrol of Hospitalinfection.
• A highsense ofawarenessand training
goesa long way incontrollingHospital
infection.

53. 53
SoapWater andCommon sense are Best Antiseptics-
(William Osler)

54. ‫اإلسالمي‬‫الطب‬‫يخ‬‫ر‬‫تا‬ ‫في‬ ‫املشافي‬‫ى‬‫عدو‬
•‫لت‬ ‫املستشفيات‬‫في‬ ‫ذ‬
َ
‫خ‬
َّ
‫ت‬
ُ
‫ت‬‫كانت‬ ‫التي‬ ‫اإلجراءات‬‫ا‬ َّ‫أم‬‫ى‬‫العدو‬‫ب‬
ُّ
‫جن‬
‫املستش‬‫دخل‬ ‫إذا‬‫املريض‬ ‫فكان‬ ‫فريد؛‬ ٍّ‫خاص‬ ‫نوع‬‫من‬‫فكانت‬‫م‬ِّ‫ل‬ َ‫س‬ُ‫ي‬ ‫فى‬
‫مل‬‫مجانية؛‬ ‫جديدة‬‫مالبس‬‫ى‬
َ
‫ط‬ْ‫ع‬ُ‫ي‬ ‫ثم‬ ،‫بها‬‫دخل‬ ‫التي‬‫مالبسه‬‫انتقال‬ ‫نع‬
‫ي‬ ‫ثم‬،‫مرض‬ ‫حين‬‫يرتديها‬ ‫كان‬‫التي‬ ‫مالبسه‬‫طريق‬ ‫عن‬‫ى‬‫العدو‬‫كل‬ ‫دخل‬
‫الع‬‫ل‬‫بدخو‬ ‫له‬‫سمح‬ُ‫ي‬‫وال‬ ،‫بمرضه‬ ٍّ‫مختص‬‫عنبر‬‫في‬ ‫مريض‬‫؛‬‫ى‬‫األخر‬‫نابر‬
ٍّ‫خاص‬‫سرير‬‫على‬‫مريض‬ ‫كل‬‫وينام‬ ،‫ا‬ً‫أيض‬‫ى‬‫العدو‬ ‫انتقال‬ ‫ملنع‬،‫به‬
‫وعليه‬‫مالءات‬‫ة‬َّ‫خاص‬ ‫وأدوات‬ ‫جديدة‬.
•http://islamstory.com/ar/