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HEALTH CARE ASSOCIATED INFECTION

HEALTH CARE ASSOCIATED INFECTION. دکترافشین محمد علیزاده متخصص عفونی عضوهیئت علمی دانشگاه علوم پزشکی شهیدبهشتی بیمارستان آیت ا...طالقانی. What is a Nosocomial Infection ?.

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HEALTH CARE ASSOCIATED INFECTION

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  1. HEALTH CARE ASSOCIATED INFECTION دکترافشین محمد علیزاده متخصص عفونی عضوهیئت علمی دانشگاه علوم پزشکی شهیدبهشتی بیمارستان آیت ا...طالقانی

  2. What is a Nosocomial Infection ? • An infection which is acquired during hospitalization and which was not present or incubating at the time of admission • An infection which is acquired in the hospital and becomes evident after discharge from the hospital • A newborn infection which is the result of passage through the birth canal • A surgical site infection(SSI) after less than 30 days. • A surgical site infection(SSI) after less than one year from device insertion.

  3. What is a Nosocomial Infection ? Practically - to establish that an infection is hospital acquired, SHOW THAT the patient: 1. HAS AN INFECTION, not a simple colonization 2. WAS NOT infected at the time of admission 3. HAD SUFFICIENT TIME to develop infection

  4. The risk of infection is always present. • Patient may acquire infection before admission to the hospital = Community acquired infection. • Patient may get infected inside the hospital = Nosocomial infection. • It includes infections • not present nor incubating at admission, • infections that appear more than 48 hours after admission, • those acquired in the hospital but appear after discharge • also occupational infections among staff.

  5. True Infection NOT Colonization 1 • Infections are accompanied by signs and symptoms: •  fever, malaise •  in localized infections: swelling due to inflammation, heat, pain, erythema • Use definitions which establish minimum characteristics for infection • Remember: Immunocompromised patients do not show signs of infection as normal patients. Neutropenic patients (  500 neutrophils /mm3) show no pyuria, no purulent sputum, little infiltrate and no large consolidation on chest X-ray

  6. NO Infection at Time of Admission 2 • establish prior negativity • check history, symptoms and signs • documented at time of admission, lab tests & chest X-rays done -normal physical examination -absence of signs and symptoms -normal chest X-ray -negative culture or lack of culture Example: If urine cultures are collected at day 7 of hospitalization and none was collected before, it implies that no signs of infection were present in urine before

  7. Sufficient Time to Develop Infection 3 • diseases with specific incubation period: stay in hospital  incubation period • numerous infections do not have well set incubation periods (for example, staphylococci, E.coli infections) - these infections rarely develop in less than 2 days

  8. Blood Stream InfectionsBSI

  9. Surgical Site InfectionSSI

  10. Urinary Tract InfectionUTI

  11. Respiratory Tract InfectionRTI

  12. Criteria of Nosocomial Infections

  13. Frequency of Nosocomial Infection • Nosocomial infections occur worldwide. • The incidence is about 5-8% of hospitalized patients, 1/3 of which is preventable. • The highest frequencies are in East Mediterranean and South-East Asia. • A high frequency of N.I. is evidence of poor quality health service delivered.

  14. Distribution of HCAI • Urinary tract infections (27 %). • Lower respiratory tract infections including pneumonia (24 %). • Surgical site infections (17 %). • Bloodstream infections (10.5 %). • Others including diarrhoea due to Clostridium difficile. Ref: ecdc.europa.eu

  15. Challenges of HCAI • Increased Mortality- “Approximately 4.1 million European patients acquire a HAI annually and 37,000 of these patients die as a direct consequence of their infection”. • Increased Morbidity – increased length of stay (4 days per infection). • Increased Cost- hospital costs & post discharge costs increased 3 times. • Negative impact on the well being of patients. • 20-30% HCAI are preventable. Ref :ecdc.europa.eu

  16. National Healthcare Safety NetworkNHSN Established in 2005 by the Centers for Disease Control and Prevention (CDC) to integrate the former CDC surveillance systems: • National Nosocomial Infections Surveillance System (NNIS) • Dialysis Surveillance Network (DSN) • National Surveillance System for Healthcare Workers (NaSH)

  17. The NHSN Agreement to Participate and Consent is a user agreement and data consent form required to use NHSN, the recognized gold-standard surveillance system for healthcare-associated infections (HAIs). The document details the purposes of NHSN and data access and protection provisions. Facilities that request NHSN access must have a senior executive review, sign, and return the form to CDC. Instructions are with the form.

  18. THANK YOU

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