HAI

1. HEALTHCARE
ASSOCIATED
INFECTION (HAI)

2. HEALTHCARE ASSOCIATED
INFECTION (HAI)
2
Also known as Nosocomial infection /
/Hospital acquired infection
/ Hospital associated infection
Also occupational infections among staff
For patients : Infections that first
appear 48hrs or more after hospital
admission or within 30 days after
discharge.

3. Some Statistics for HAI:
Affects ~ 10% of all in-patients
Delays discharge
Costs 2 x more than if there is
no infection
Show increasing
trend among patients
and staff
3

4. 4
Crowded hospital conditions
New microorganism
Increasing people with
compromised immune system
Increasing Bacterial resistance
(MRSA,resistant Gram negatives)
HAI reducible by 10-
30%
RISE IN HAI AS A RESULT OF 4 FACTORS

5. HAI - EPIDEMIOLOGY
5
Can be exogenous (external organism) and
endogenous (opportunist normal flora)
Host susceptibility : important factor in
development of HAI
MEDICAL EQUIPMENTS AND
PROCEDURES (surgery) are often responsible
for infections

6. HAI :Mode of Transmission
 Contact/hand borne (most common)
 Air borne

 Oral route
 Parenteral route
 Vector borne
6

7. 1. Contact (most common)
Direct (physical contact)
◦ eg when a staff turns a
patient, gives patient a
bath , examination of
patient
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8. 8
Indirect-contact Transmission
Involves contact of a host with a contaminated
intermediate object ， eg:
 Contaminated instruments / needles/dressings
 Contaminated gloves that are not changed
between patient.
 Contaminated surface by needles (Jarum diletak
atas permukaan selepas ambil darah ! ）》》》
 Dried blood can transmit HEPATITIS B/C

9. 9
RISIKO HAI
Hep B virus can live outside d body
at least 7 days
Hep C virus can live outside d body
for 16h - 4 days

10. 10
2.VECTOR TRANSMISSION
Transmitted through insects
eg mosquitoes and fleas.
( eg Denggi)
3.AIR BORNE TRANSMISSION
Tiny droplet nuclei that
remain suspended in air.
（ Eg TB)

11. 11
4.DROPLET TRANSMISSION
Droplet generated by sneezing,
coughing or respiratory tract
procedures eg suction
EX : Influenza,TB

12. AGENTS OF HA INFECTIONS
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VIRUS
BACTERIA
FUNGI

13. Hospital Procedure Pose Many
Risks to HAI
Nebuliser mask
Catheterization
IV Procedure
Dressing
Bedpans
Urinals
Dirty couch etc.
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14. Predisposing Factors fOR
HAI
Age （ Young children ，
Elderly ）
Severity of Illness
Medical conditions
Immuno compromised
Malnutrition
Obesity
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15. COMMON SITES OF HAI
 Patients in Labour Room / ICU
 Patients undergoing invasive
procedures /operation.
 Areas of hospital with poor ventilation
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16. 5 COMMON TYPES OF HAI
1. Urinary Tract Infections (UTI)
2. Surgical Wounds Infections (SWI)
3. Pneumonia
4. Skin
5. Blood stream infection/
Bacteremia
 Staff : URTI/ Conjunctivitis
/Pertussis/TB etc
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17. COMMON SITES OF INFECTION
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19. URINARYTRACT INFECTIONS
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Most common cause of HAI
80% of UTI are associated
with indwelling catheters.

20. SURGICAL SITE INFECTIONS
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Frequent
Definition is mainly clinical
(purulent discharge around wounds
or at insertion site of drain, or
spreading cellulites from wounds)
The infections can be exogenously
or endogenously

21. NOSOCOMIAL PNEUMONIA
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Most important are patients
on ventilators in ICU.
Recent and progressive
radiological opacities of
pulmonary parenchyma,
purulent sputum and recent onset
fever.

22. PREVENTION & CONTROL OF HAI
1. Observance of aseptic technique
2. FREQUENT HAND WASHING
esp. between patients
3. Cleaning, and disinfection of
linen and furniture etc)
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23. 23
PPE:Wear Gloves
For two reasons:
Provide a protective barrier
and prevent contamination of
hands
Reduce likelihood that
microorganism present on
hands will be transmitted
to patients during procedure.

24. 3.

25. HAND HYGIENETO PREVENT HAI
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 You can get 100s to 1000s of bacteria on your
hands by doing simple tasks like:Assisting pt
up in bed /Touching pt’s gown or bed sheets
HandWashing is Important Because…
80% of disease is spread by your hands.
Hand Hygiene : single most effective
intervention to reduce the cross
transmission of HAI

26. PREVENTION & CONTROL OF HAI
4. Sterilization of instrument eg
nebulizer/oxygen mask/Use of
single-use disposable items
5. Patient isolation eg Pertussis/TB
etc
6. Avoidance of medical
procedures that can lead to HAI
( eg. urinary catheter)
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27. HAI :What is most Important
 Effective surveillance and
action by infection control
team to reduce infection
rates.
 Important role of team :
monitor compliance and
practices to prevent HAI

28. EXAMPLE OF HAI
TB in HCW
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29. HCW - TB Cases & Notification Rate, Malaysia 2003-
2014
Control & Prevention Measures of TB among HCWs
Risk for TB among HCWs is consistently higher than
general population worldwide (Joshi, 2006)
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30. ii. ADMINISTRATIVE CONTROL
• Periodic TB Screening for HCWs
Control & Prevention Measures of TB among HCWs
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31. iii. PPE
• N95 (respirator) must be used in high risk TB
areas
 TB ward, chest clinic
 Isolation room
 Procedure room
eg. sputum induction room
• HCW to use N95
• Patient to use Surgical Mask
Control & Prevention Measures of TB among HCWs
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32. Control & Prevention Measures of TB among HCWs
Conclusion
In addition to having TB guidelines with
environmental / engineering;
administrative; and respiratory-
protection controls;
HCWs must change their behaviour
towards healthy and safer work culture
in order to prevent & control TB at the
workplace.
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33. Thank YouThank You33