helpful for medical as well as paramedical students

1. HOSPITAL
ACQUIRED
INFECTION
- K H YAT I C H A U D H A R I

2. WHAT IS HAI ?
• Hospital acquired infection(HAI) is are infections acquired during hospital care
which are not present at admission.
• Infections occurring more than 48 hours after admission are usually
considered nosocomial.

3. DEFINITION
• A hospital acquired infection also known as nosocomial
infection, is an infection that is acquired during hospital care
which are not present at the time of admission.

4. HAI- BURDEN
• HAI occur worldwide and affect both developed and resource-poor countries.
• Over 1.4 million people worldwide suffer from such infections
• Most frequent of these are-
Infections of surgical wounds
Urinary tract infections
Lower respiratory tract infections

5. WHY DO PATIENT IN HOSPITAL
ACQUIRED INFECTION ?
• Patients with infectious disease are frequently admitted to hospital.
• Some of these patients are able to spread their organisms to other patients
and they provide one source of infection in hospital patients admitted for other
causes

6. WHY DO PATIENT IN HOSPITAL
ACQUIRED INFECTION ?
• When such patients require admission to hospital, the risk has to be assessed
for other patients.
• Appropriate measures have to be taken to contain the infection with isolation
procedures of varying degrees of strictness depending on the infection.

7. WHY DO PATIENT IN HOSPITAL
ACQUIRED INFECTION ?
• The commonest forms of HAI are due to invasive procedures carried out on
patients such as :
Surgical operations
Intravenous therapy
Intubation
catheterization

8. SURGICAL OPERATIONS

9. IV THERAPY

10. INTUBATION
• Intubation is the process of
inserting a tube, called
an endotracheal tube (ET),
through the mouth and then into
the airway.

11. CATHETERIZATION

12. • Immunodeficiency of varying degrees is seen in many of the patients admitted
to hospital. These include :
Patients at the extremes of age
Patients with diabetes
Receiving immunosuppressive drugs
Patients with cancer, in particular those undergoing chemotherapy
• These patients are prone to infection with bacteria which have little threat for
healthy persons.
WHY DO PATIENTS IN HOSPITAL
ACQUIRE INFECTION?

13. CHAIN OF INFECTION
• There are six
elements in
the cycle of
infection, and
all six must
be present
before the
transmission
of infection
can take
place.

15. SOURCES OF INFECTION

16. SOURCES OF INFECTION
 Exogenous sources
Other patients (cross-infection)
Health care workers
Inanimate objects (fomites) vehicle- such as clothes, utensils, furniture and
book etc.
Inanimate environment of the hospital: which include -- contaminated air,
water, food -- contaminated equipment & instrument -- solid linen -- hospital
waste

17. SOURCES OF INFECTION
 Endogenous sources
When normal patient flora change to pathogenic bacteria because of change
of habitat, damage of skin and inappropriate antibiotic use.
About 50% of HAIs are caused by this way.
This happen when normal bacterial flora enter a sterile area of the body such
as the brain or muscle.
Example : when residential bacterium E.coli. Of the GI tract enters the urinary
tract.

18. ROUTES OF
INFECTION IN
HOSPITAL
• IV line

19. ROUTES OF INFECTION IN HOSPITAL

20. ANTIMICROBIAL RESISTANCE
• Antimicrobial resistance (AMR) is the ability of a microbe to resist the effects of
medication previously used to treat them
• Resistant microbes are increasingly difficult to treat, requiring alternative
medications or higher doses → which may be more costly or more toxic.

21. HOSPITAL
INFECTION
PREVENTION &
CONTROL
GUIDELINES N O V E M B E R , 2 0 1 5
N AT I O N A L C E N T E R F O R D I S E A S E
C O N T R O L

22. INFECTION CONTROL COMMITTEE
• Integral component of the patient safety program of the health care facility, and
is responsible for establishing and maintaining infection prevention and control,
its monitoring, surveillance, reporting, research and education.

23. STRUCTURE
• 1.Chairperson: Head of the Institute (preferably)
• 2.Member Secretary: Senior Microbiologist
• 3.Members: Representation from Management /Administration (Dean/Director of
Hospital, Nursing Services, Medical Services, Operations)
• 4.Relevant Medical Faculties
• 5.Support Services: (OT/CSSD, Housekeeping / Sanitation, Engineering,
Pharmacologist, Store Officer / Materials Department)
• 6.Infection Control Nurse
• 7.Infection Control officer

24. AIM OF STERILIZATION: ASEPSIS
• Asepsis is the practice to reduce or eliminate contaminants (such as bacteria,
viruses, fungi and parasites) from entering the operative field in surgery or
medicine to prevent infection.

25. METHODS IN STERILIZATION
• Physical Methods
• Moist heat in Autoclave
• Dry heat in ovens
• Gamma irradiation
• Filtration
• Plasma sterilization
• Chemical Methods
• Ethylene oxide
• Glutaraldehyde (high
concentration)

26. METHODS IN DISINFECTION
• Physical Methods
• Boiling & Pasteurization
• UV radiation
• Chemical Agents
• Alcohols
• Aldehydes
• Halogens
• Phenols
• Surfactants
• Heavy metals
• Dyes
• Oxidants

27. GENERAL GUIDELINES FOR
DISINFECTION
• Critical instruments/equipment
– (that are those penetrating skin or mucous membrane) should undergo
sterilization before and after use. Ex: surgical instruments.
• Semi-critical instruments / equipment
– (that are those in contact with intact mucous membrane without
penetration) should undergo high level disinfection before use and
intermediate level disinfection after use. Ex: endotracheal tubes

28. GENERAL GUIDELINES FOR
DISINFECTION
• Non-critical instruments /equipment
– (that are those in contact only with intact skin) require only intermediate or
low level disinfection before and after use. Ex: ECG electrodes

29. ROLE OF PHYSICIAN
• Physicians have unique responsibilities for the prevention and control of
hospital infections:
By providing direct patient care using practices which minimize infection
By following appropriate practice of hygiene (e.g. handwashing, isolation)
Protecting their own patients from other infected patients and from hospital
staff who may be infected

30. ROLE OF PHYSICIAN
Complying with the practices approved by the Infection Control Committee
Obtaining appropriate microbiological specimens when an infection is present
or suspected
Notifying cases of hospital-acquired infection to the team, as well as the
admission of infected patients

31. ROLE OF THE HOSPITAL PHARMACIST
• The hospital pharmacist is responsible for:
Obtaining, storing and distributing pharmaceutical preparations using
practices which limit transmission of infectious agents to patients
Maintaining records of antibiotics distributed to the medical departments

32. ROLE OF THE HOSPITAL PHARMACIST
Providing the Antimicrobial Use Committee and Infection Control Committee
with summary reports and trends of antimicrobial use.
Providing summary reports of prevalence of resistance monitoring sterilization,
disinfection and the environment where necessary
Participation in development of guidelines for antiseptics, disinfectants, and
products used

33. ROLE OF THE NURSING STAFF
• Implementation of patient care practices for infection control is the role of the
nursing staff.
• The senior nursing administrator is responsible for:
Participating in the Infection Control Committee
Promoting the development and improvement of nursing techniques
ongoing review of aseptic nursing policies, with approval by the Infection
Control Committee

34. CENTRAL STERILIZATION SERVICE
• As central sterilization department serves all hospital areas, including the
operating suite, an appropriately qualified individual must be responsible for
management of the infection control program.
Oversee the use of different methods - physical, chemical, and bacteriological
to monitor the sterilization process
Ensure technical maintenance of the equipment according to national
standards and manufacturers’ recommendations

35. ROLE OF THE FOOD SERVICE
• The in-charge of food services must be knowledgeable in food safety, staff
training, storage and preparation of foodstuffs, job analysis and use of
equipment.
• The head of catering services is responsible for:
Defining the criteria for the purchase of foodstuffs
Equipment use
Cleaning procedures to maintain a high level of food safety

36. ROLE OF THE LAUNDRY SERVICE
• The laundry is responsible for:
Developing policies for working clothes in each area and group of staff, and
maintaining appropriate supplies
Ensuring that liquid soap and paper towel dispensers are replenished
regularly

37. ROLE OF THE LAUNDRY SERVICE
Distribution of working clothes and, if necessary, managing changing rooms.
Developing policies for the collection and transport of dirty linen.
Defining, where necessary, the method for disinfecting infected linen, either
before it is taken to the laundry or in the laundry itself

38. ROLE OF THE HOUSEKEEPING SERVICE
• The housekeeping service is responsible for the regular and routine cleaning
of all surfaces and maintaining a high level of hygiene in the facility.
Classifying the different hospital areas by varying need for cleaning
Developing policies for appropriate cleaning techniques: procedure,
frequency, agents used, etc., for each type of room, from highly contaminated to
the most clean.

39. ROLE OF THE HOUSEKEEPING SERVICE
Developing policies for collection, transport and disposal of different types of
waste (e.g. containers, frequency)
Ensuring that liquid soap and paper towel dispensers are replenished
regularly
Informing the maintenance service of any building problems requiring repair

40. ROLE OF THE INFECTION CONTROL
TEAM
• The infection control program is responsible for:
Oversight and coordination of all infection control activities to ensure an
effective program.
Organizing an epidemiological surveillance program for nosocomial infections
Participating with pharmacy in developing a program or supervising the use of
anti-infective drugs
Ensuring patient care practices are appropriate to the level of patient risk

41. UNIVERSAL/STANDARD PRECAUTIONS
FOR INFECTION CONTROL
• 1.Hand hygiene
• 2.Personnel protective equipment
• 3.Safe handling and disposal of
sharps
• 4.Follow needle stick injury
protocol
• 5.Safe handling and disposal of
wastes
• 6.Managing blood and body fluids
• 7.Disinfection of equipment
• 8.Environmental disinfection
• 9.Immunization
• 10.Isolation

44. PERSONAL PROTECTIVE EQUIPMENT
• Must be used whenever high risk patient is being handled
Gloves
Disposable plastic Apron
Masks.
Eye protection

45. SAFE HANDLING AND DISPOSAL OF
SHARPS
The main hazards of a sharps injury
are:
• Hepatitis B,
• Hepatitis C,
• HIV.
Ensure that:
• Sharps are not passed from hand to
hand.
• Needles are not broken or bent before
use.
• Sharps are disposed of at the point of
use.
• Sharp containers are not filled more than
two third.
• Staff are aware of inoculation injury
policy.

46. FOLLOW NEEDLE STICK INJURY
PROTOCOL
1. Irrigate mucous membranes by washing under running water
2. Do not suck/ Squeeze the injury site
3. Wash with soap and water
4. Apply antiseptic lotion to the injury site.
5. Contact emergency room-medical officer for management
6. Complete the incident report & inform to ICN

47. SAFE HANDLING AND DISPOSAL OF
WASTE
• Segregate the waste at source.
• Know the policies and protocols of the state.
• Safe disposal.
• Safe handling of spillage.

48. MANAGING BLOOD AND BODILY
FLUIDS
• Handle specimens safely: Collection → Labeling → Transfer
• Dealing with spillage:
Small spill/ spotted Spill
Large Spill

49. MANAGING BLOOD AND BODILY
FLUIDS
• Management of small spill:
Wear gloves and eye protection
Contamination should be wiped up
with paper towels soaked in freshly
prepared Hypochlorite solution (1%)
If broken glasses are present, first
treat the spillage with Hypochlorite, then
carefully remove the glass piece with
disposable forceps and wipe it up
Towel and glasses should be disposed
off in a yellow clinical waste bag for
Incineration
Wash hands

50. MANAGING BLOOD AND BODILY
FLUIDS
• Management of large spill:
Mark that area as large spill
Wear PPE
Liquid spill should be covered up
with Hypochlorite solution and left for
2 min.
Use absorbent to absorb
Wipe that with water and detergent
Allow that to dry
Put all the towels, gloves to yellow
bin for incineration

51. QUESTION
• Define hospital acquired infection. Describe various sources and
preventive measure use in hospital.