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HEALTH CARE ASSOCIATED INFECTIONS AND ITS CONTROL. Prof Victor Lim International Medical University. HEALTH CARE ASSOCIATED INFECTION. Definition Any infection acquired by patients or members of staff while in a heath care setting
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HEALTH CARE ASSOCIATED INFECTIONS AND ITS CONTROL Prof Victor Lim International Medical University
HEALTH CARE ASSOCIATED INFECTION • Definition • Any infection acquired by patients or members of staff while in a heath care setting • Does not include infections which manifest in a health care setting but acquired outside the health care setting • Includes infections acquired in a health care setting but manifest after discharge
NOSOCOMIAL OR HOSPITAL ACQUIRED INFECTION • Old term • Nosocomium = Hospital • Increasing day-care and ambulatory care in modern medical practice • Chronic care facilities, nursing homes • Confining definitions to hospitals only may not reflect the true situation • Infection control is also important in non-hospital settings – hence health-care associated infections
History of Nosocomial Infection • Ignaz Semmelweis, (1840s) demonstrated importance of hand hygiene • No progress for next century • 1976, the Joint Commission on Accreditation of Healthcare Organizations - standards for infection control • Nosocomial infection still on the increase - emerging infection
Reasons for Re-emergence • Antibiotic resistance : HCAI becoming more difficult to treat • Increased numbers of vulnerable patients • progress in medical management • increasing day-care & ambulatory care • Failure of staff to comply with infection control procedures
CAUSES OF HCAI • Virtually all microorganisms can cause nosocomial infections • Viruses • Bacteria • Fungi • Parasites
BACTERIA • Bacteria • Gram + • Staphylococcus aureus • Staphylococcus epidermidis • Gram - • Enterobacteriaceae • Pseudomonas aeruginosa • Acinetobacter baumanni • Mycobacterium tuberculosis
NOSOCOMIAL PATHOGENS • Viruses • Blood borne infections : HBV, HCV, HIV • Others: CMV, rubella, varicella, SARS • Fungi • Candida • Aspergillus
SOURCES OF INFECTION • Endogenous • source is the normal flora or colonisers of skin and other epithelial surfaces • Exogenous • other persons (cross-infection) • inanimate objects (fomites)
SPREAD OF INFECTONS • Air-borne • Skin scales, droplet nuclei • Contact • Direct • Hands & clothing • Droplet contact followed by autoinoculation • Clinical equipment • Indirect • Bedpans, bowls, jugs, etc
SPREAD OF INFECTONS The hands are the most important vehicle of transmission of HCAI
National NI prevalence rates : Ministry of Health and Teaching Hospitals
TYPES OF INFECTIONS • Common infections • Urinary tract infections • Surgical wound infections • Lower respiratory infections • Traumatic wounds and burns infections • Primary bacteraemia
Types of infections : National Surveillance Percentage
COST OF INFECTIONS United Kingdom 115 million pounds (1988) United States of America 5 billion dollars (1987) 4.5 billion dollars (1995) Malaysia ???
CONTROL OF HCAI Hand hygiene is the single most important measure for control of nosocomial infections
TYPES OF HAND HYGIENE PROCEDURES • Hand washing • Hand washing is usually limited to hands and wrists • Hands are washed for a minimum of 10 – 15 seconds with soap (plain or antimicrobial) and water • Transient micro-organisms are mechanically removed by rinsing. • Hand antisepsis/decontamination • Hand antisepsis removes or destroys transient micro-organisms and confers a prolonged effect. • Two ways: • Wash hands and forearms with antimicrobial soap and water, for 15-30 seconds • Decontaminate hands with a waterless, alcohol-based hand gel or hand rub for 15-30 seconds. Appropriate for hands that are not soiled with protein matter or fat.
TYPES OF HAND HYGIENE PROCEDURES • Surgical hand antisepsis • Removes or destroys transient micro-organisms and confers a prolonged effect. • Hands and forearms are washed thoroughly with an antiseptic soap for a minimum of 2-3 minutes. • Hands are dried using a sterile towel. • Required before performing invasive procedures.
HAND WASHING TECHNIQUE Source: World Health Organization. Regional Office for Western Pacific.
COMPOUNDS FOR HAND ANTI-SEPSIS • Recommended by WHO • 2%-4% chlorhexidine, • 5%-7.5% povidone iodine, • 1% triclosan, or • 70% alcoholic hand rubs.
WHO FIRST GLOBAL PATIENT SAFETY CHALLENGE • Clean care is safer care • Alcohol-based hand rubs must be available at the point of care • As effective as washing with soap or antiseptic and water • More convenient and less time consuming
THE SWISS EXPERIENCE • A hand hygiene campaign was launched in January 2006, in 116 hospitals nationwide. • Alcohol-based hand rubs were available at the patient bedside or carried by staff in their pocket. • Overall hand hygiene compliance increased from 54% to 68% - a 25% boost in patient safety. • Nurses’ compliance is 72%. Doctors’ compliance showed an increase of 33% to an encouraging 60% • Prevented 17,000 infections and saved CHF 60 million nationwide. • Hand rubbing now accounts for up to 97% of all hand hygiene actions in Swiss hospitals Source : WHO
OTHER MEASURES • Practise aseptic techniques when performing procedures • Limit the duration of in-situ catheters (urinary and intravascular) to shortest possible • Meticulous care of lines, ventilator tubing, catheters and wounds
OTHER MEASURES • Isolation of infectious patients and immuno-compromised patients • Source isolation • Protective isolation • Use of single rooms with bathroom attached • Use of positive or negative pressure rooms • Protect yourself appropriately through good practices and using personal protective equipment (STANDARD PRECAUTIONS)
PROTECT YOURSELF THROUGH IMMUNISATION Immunisation BCG Hepatitis B Tetanus Rubella Varicella Influenza
CONCLUSIONS • Preventing HCAI is a very important aspect of patient safety • All health care personnel must practise the highest standards of infection control as HCAIs • Cause significant morbidity and mortality to patients and health care staff • Contribute to increasing prevalence of antibiotic resistance • Are difficult and expensive to manage • Can result in medical litigation