Health Care Associated Infections ( Nosocomial infections)

1. Health Care Associated Infections (Nosocomial infections) By Dr.SabahM.A.Abdelkader Assist. Prof. of Public Health

2. Objectives • By the end of this lecture, students should be able to: • Define NCIs correctly. • Recognize categories of NCIs. • Discuss descriptive epidemiology of NCIs • Identify components of NCIs control. • Analyze effective control programs.

3. Introduction • HAIs is cross infection of one patient by another or by doctors, nurses and other hospital staff while in hospital. • A high frequency of NCIs is evidence of poor quality of health service delivery. • Many factors contribute to frequency of NCIs. • NCIs may be endemic or epidemic. • Changes in health care delivery have resulted in shorter hospital stay and increased outpatient care.

5. Definition • Health Care Associated Infections (HAIs) or nosocomial infections (NCIs) are infections that acquired in patients during or associated with delivery of health care which are not present at admission. • Infections occurring more than 48 hours after admission are considered NCIs.

6. Categories of HAIs • Certain sites are particularly common: • 1-Urinary Tract Infections: The most common infection (30%) of HAIs is mainly due to use of catheters. • 2-Surgical Wound Infections: • The second most common HAIs.

7. Cont. • 3-Lower Respiratory Infections: Pneumonias are responsible for 15% of HAIs. • The most common fatal HAIs( case fatality rate of about 30%). • Endotracheal intubations is a risk factor for pneumonia. • 4-Bloodstream Infections: It is the most common site of HAIs among neonates in high-risk nurseries. • 5- Diseases transmitted parentrallyor through unscreened blood transfusion such as HIV, HBV, HCV, HDV, malaria and syphilis

8. Descriptive Epidemiology. • I – Person • II – Place • III - Time

9. I - Person • 1- Age: Newborn babies and elderly are at a higher risk of HAIs. • 2- Malnourished patients are more likely to acquire nosocomial infections. • 3-Comorbidities:chronic debilitating diseases and severity of underlying diseases.

10. Cont. • 4-Use of invasive procedures , potent immunosuppressive, chemotherapeutic agents. These drugs affect the host’s normal colonizing flora, cause skin and mucous membrane breakdown and impair the function of the immune system. • 5- Prolonged hospitalization. • 6- Other personal characteristics : marital status, sex & socioeconomic status may reflect the type of hospital attended and the level of health care provided.

11. II - Place • The frequency of HAIs differs between hospitals and even between different units within the same hospital. This difference is attributed to • - The level of infection control program. • - The nature of the procedure carried. • - The characteristic and the type of patients attended.

12. Cont. • Examples:The frequency of HAIs is higher in the secondary health care facilities than that in the primary health care ones. • The frequency of the HAIs is greater in intensive care units (ICU) burn units, urology units than that in the other units.

13. III - Time • Outbreaks of HAIs may occur particularly those related to parenteral injection and surgery if medical staffs are not adequately trained.

14. Sources of infection • I – Patients. • II – Staff. • III – Environment.

15. I - Patients • Viral infections e.g measles, influenza. • Skin infections e.g. discharging wounds. • Respiratory infections e.g pneumonia. • Urinary tract infection e.g B coli infection.

16. II - Staff • Doctors, nurses, ward boys who come in close contact with patients. • Staph aureus carried in nose or skin. • Hemolytic strept carried in the throat. • Salmonella carried in GIT.

17. III - Environment • Hospital environment (through hospital dust, linen, bed clothes, furniture, basins, door handles) is laden with microorganisms forming an important source of infection.

18. Routes of infection • Direct contact from hands of a nurse or doctor to a susceptible patient. • Droplet infection through cough or sneezing. • Air-borne infection e.g TB • Release of hospital dust into the air. • Various hospital procedures e.g IV, catheters, infected cat gut, dressings, bed pans, sputum cups.

19. Recipients • All patients in hospitals are potential recipients. • Some are more susceptible than others. • NCIs are more in ICU, urological, geriatric wards and special baby care units.

20. Components of effective health care associated Infections control Program. • I- Surveillance. • II-Control Measures. • III-Available qualified well trained personnel: • A- Infection Control Practitioner. • b- Hospital Epidemiologist.

21. I-Surveillance • It should be conducted prospectively before patients are discharged. • Data collected during surveillance of HAIs are: • 1- Infection rates by site, pathogen, specialty service and patient care area, surgeon-specific wound infection rates, and procedure-specific rates should be calculated monthly and reported to hospital staff.

22. Cont. • 2-Data related to the practices provided to the patients to ensure the implementation of infection control measures (Such as aseptic technique during invasive procedures) • 3- Data related to environmental practices that control the microbiological agents such as sterilization and disinfection procedures.

23. II-Control Measures • 1- Isolation: infectious patients must be isolated. Patients susceptible to infection should not be placed near source of infection. • 2- Hospital staff suffering from skin diseases, sore throat, common cold, ear infection, diarrhea, dysentery should be kept away from work until complete cure.

24. Cont. • 3-Hand hygiene: Wash hand after touching blood, secretions, excretions and contaminated articles and after removing gloves. Use plain soap for routine hand washing and antimicrobial agent for specific circumstances. • 4-Personal protective equipment (PPE).These include gloves, splash shields and eye protection and are used whenever there is a risk of exposure to blood or other infective material.

25. Cont. • 5-Aseptic techniques: Surgical scrub and gloving, sterile field and using good surgical technique. • 6-Reprocessing of used instruments and sterile devices: Ensure that reusable equipment is not used for the care of another patient until it has been cleaned and reprocessed properly.

26. Cont. • 7- Environmental cleaning: Cleaning and disinfection of environmental surfaces should be routinely done. • 8- Proper sharps and waste disposal: Take care to prevent injuries when using needles, scalpels and other sharp instruments and devices.

27. III-Available qualified well trained personnel • A-Infection control practitioner: • At least one full-time infection control practitioner (ICP) for every 250 hospital beds is required. The main duties of ICP are: • -Collecting and analyzing surveillance data. • -Assisting in development of IC procedures. • -Education and consultation to other staff.

28. B-Hospital epidemiologist: • -Supervises the IC practitioners. • -Provides liaison with other members of medical staff. • -Provides advice about surveillance. • -Conducting epidemiologic studies required investigating outbreaks of HAI. • -Development of infection control measures.

29. Routine precautions • Health workers are at risk of acquiring infection through occupational exposure. • Employee’s health should be reviewed at recruitment: immunization, previous exposure, serological tests: AIDS, hepatitis A-B-C, TB.

30. Thank you