Infection Control & Related Microbiology DAHS 1010, DAHS 2010

1. Infection Control & Related Microbiology DAHS 1010, DAHS 2010 Healthcare Associated Infection Beverley Gallacher

2. Learning outcomes • Define Hospital Acquired Infection (HAI) • Examine the scale of HAI in England • Discuss the estimated costs of HAI • Describe the prevention & treatment of specific HAI’s

3. Hospital Acquired (Nosocomial) Infections • One that is neither present or incubating at the time when a patient is admitted to hospital • If patients acquire an infection more than 72 hours after admission it is considered to be hospital acquired rather than community acquired

4. The Scale of the Problem • “At any given time, some 9% of patients in hospital have a HAI” (NAO report 2000) • Based on a survey of 37,111 patients in 15 centres, from May 1993 to July 1994 Emmerson et al (1996) in NAO report (2000)

5. Most Common Types of HAI 6.2% 23.2% • Blood (septicaemia) • Urinary tract • Surgical wound • Lower respiratory tract • Skin 72.6% approx  10.7% 22.9% 9.6% • “Other” - specific infectious diseases; influenza, viral gastroenteritis, & in rare cases legionnella & tuberculosis etc.

6. Estimated Costs to the N.H.S. (NAO Report 2000) • £1 billion / year • Based on extrapolation of results from one hospital to the rest of the NHS • “Attributing costs to hospital acquired infection is complex and uncertain” • Why? • Many factors involved in costs. Estimate how many extra days inpatient stay resulted from the HAI

7. Statistics from that “one hospital” • 13 month period - 7.8% patients acquired an infection • A further 19.1% reported symptoms of, and in some cases received treatment for, infection manifesting itself post discharge • Infected patients cost 2.8x more than uninfected. (Average £2,917, £1,122 - UTI, £6,209 - bloodstream) • Infected in hospital 2.5x longer than uninfected (Average 11 days)

8. Estimated “Human” Costs to the NHS Longer inpatient stay Death Permanent disability Discomfort Extrapolate U.S.data - 1% all deaths primarily due to HAI Difficult to estimate, no UK data available

9. Prevention & Treatment of HAI’s • Estimated that 30% of HAI’s are preventable. • Why not 100%? • How are they preventable? “By putting infection control and basic hygiene at the heart of good management & clinical practice” Antibiotics - resistant strains

10. Nosocomial UTI • Patients admitted to urological service • Duration of catheterisation • Pseudomonas aeruginosa, Klebsiella spp. Enterococcus faecalis. • Ascending infection

11. Surgical wound infection • Pre operative • Peri operative • Post operative • Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Klebsiella spp. • Sources, patients skin flora, hands of staff, equipment.

12. Nosocomial acute pneumonia • Most common HAI to cause death • Smokers, prior chest disease, post operative, ventilated & critically ill. • Psuedomonas aeruginosa, Staphylococcus aureus

13. Prevention of HAI - an effective infection control programme • Surveillance - trends, outbreaks, evaluate changes in clinical practice, assist the targeting of preventative efforts. • Education & training • Production, review & dissemination of written policies, procedures & guidelines • IC staff to contribute to decisions on: equipment purchasing, structural alterations & additions to building work, catering, domestic, laundry contracts • Specific documentation for dealing with infections

14. Hospital Acquired Infection HAI Healthcare Associated Infection

15. References • The Management and control of Hospital Acquired Infection in Acute NHS Trusts in England. (2000) National Audit Office. London HMSO • Inglis T. J. J. (2000) microbiology & Infection. Churchill Livingstone Edinburgh