Hospital acquired infection
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Hospital acquired infection
- 1. HOSPIAL ACQUIRED INFECTION (DEPARTMENT OF COMMUNITY MEDICINE) Moderated by- Dr. Dhiraj Srivastava Presented by- Srihari Adhikari Roll No.- 73 Batch- 2010
- 3. Definition • Hospital acquired infection / nosocomial infection are infection acquired during hospital care which are not present or incubating at admission. • Infection occurring more than 48 hours after admission are usually considered nosocomial.
- 4. • Word Nosocomial comes from the greek word nosokomeion meaning hospital (nosos= disease, komeo= to take care of)
- 5. Definition by CDC • Infection that patients acquire during the course of receiving treatment for other conditions or that health workers acquire while performing their duties within healthcare setting
- 7. Surgical site infection • Any purulent discharge or abscess or spreading cellulitis at the surgical site during the month after the operation.
- 8. Urinary infection • Positive urine culture (1 or 2 species) with at least 1o thousand bacteria/ml without clinical symptoms.
- 9. Respiratory infection Respiratory symptoms with at least 2 of the following signs appearing during hospitalization • Cough • Purulent sputum • New infiltrate on chest radiograph consistent with infection.
- 10. septicaemia • Fever or rigors and at least one positive blood culture
- 11. Vascular catheter infection • Inflammation, lymphangitis or purulent discharge at the insertion site of the catheter
- 12. Special situation that is usually HAI
- 13. Infection in neonates that result from passage through birth canal
- 14. Special situation that are not usually HAIs
- 15. Complication or extension of infection(s) already present on admission unless a change in pathogen or symptoms strongly suggest the acquisition of new infection
- 16. Infection in an infant that is known or proven to have been acquire transplacentally & become evident before 48 hour of birth
- 23. Prospective study in burn unit of a tertiary case referral centre in north india • Hospital wide study is Performed by Taneja N., Emmanuel R.,Chari P S, Sharma M. in 2004 • 71 patient developed 59 hospital acquired infection. • Infection density- 36.2 infection per 1000 patient day • Commonest- invasive wound infection
- 24. U.T.I. study in JNMC Aligarh • Performed by M. Akram, M.Shahid, A U Khan in 2007. • 100 sample infected out of 920 tested urine sample. • Infection of E. Coli- 61% Klebsiella – 22%
- 25. Hospital acquired infection can be considered from 3 angles 1) Source 2) Route of spread 3) recipients
- 26. 1) SOURCE • Patient • Staff • environment
- 27. 2) Routes of spread a) Direct contact b) Droplet infection c) Air borne particle d) Release of hospital dust into the air e) Through various hospital procedure
- 30. c) Air borne particle
- 31. d) Release of hospital dust into the air
- 32. e) Through various hospital procedure like • catheterization • Intravenous procedure • dressing • infected cat gut • sputum cups • bed pans • urinals etc.
- 33. 3) RECIPIENTS a) Patient especially severely ill & under corticosteroid therapy b) Cross infection is greater in • Intensive care unit • Urological ward • Geriatric ward • Special baby care unit
- 35. 1) Isolation of infectious patient
- 36. 2) Hospital staff • Keep away from work until completely cured
- 37. 3) Hand washing
- 38. WHO guideline for hand hygiene in health care • Washing hand with soap & water • Preferably use an alcohol based hand rub for routine hand antisepsis • When alcohol based hand rub is already used do not used antimicrobial soap concomitantly.
- 39. Perform hand hygiene • Before & after having direct contact with patients • Before handling an invasive device for patient care regardless of whether or not gloves are used • After contact with body fluid or excretion , mucus membrane, non intact skin, or wound dressing. • If moving from a contaminated body site to a clean body site during patient care. • After contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient.
- 42. 4) disinfection • Sterilization of instrument • Disinfection of article used by patient • Patients urine, faeces, sputum should be properly disinfected
- 43. 5) Dust control • Suppression of dust by wet dusting & vacuum cleaning
- 44. 6) Proper disposal of hospital waste
- 45. 7) Control of droplet infection • Face mask • Proper bed lighting • ventilation
- 46. 8) Nursing technique • Barrier nursing • Task nursing
- 47. 9) Administrative measures • There should be hospital control of infection committee
- 48. Hospital infection control committee • Medical superintendent- chairperson • Representative from major clinical departments. • Representative for nursing services. • CSSD in charge. • OT in charge. • Microbiologist.
- 49. Standard to be maintained in hospital
- 50. An attempt should be made to achieve and maintain an average count of 10-15 bacteria/cubic foot of air in hospital less than 5 bacteria/ cubic foot- minimal risk of infection more than 35 bacteria/ cubic foot of air- heightened risk
- 51. Guideline to evaluate the floor cleaning procedure Based on rodac plate count • 0-25 bacteria/cubic foot- good floor cleaning procedure • 26-50 bacteria/cubic foot- satisfactory • More than 50 bacteria/cubic foot- not satisfactory
- 52. Role of central sterile supply department (CSSD) • CSSD is an accepted feature of hospital planning.
- 53. Function of CSSD • Supply of sterile instrument & material for dressing & procedure carried out in wards & department. • Sterilization of instrument & linen for use in operation theatre
- 54. CSSD also look after • Disinfection & sterilization of medical equipment such as ventilators, baby incubators, oxygen tents etc. • Selection & distribution of single use (disposable) sterile supplies such as catheters, suction tubing & syringe.
- 55. CSSD of our hospital
- 56. • Manual steam sterilizer
- 57. • Semi- automatic steam sterilizer
- 59. ETO (ethylene trioxide) sterilizer
- 62. Gloves unit in CSSD
- 63. Glove washer
- 64. Glove dryer
- 67. References • Park’s textbook of Preventive & social medicine • Harrisons principle of internal medicine • Textbook of microbiology: Ananthnarayana • Bennett & Brachmans hospital acquired infection: William R. Jarvis • Hospital administration: Francis & De Souza • www.burnsjournal.com date 09-07-2012 • www.ann-clinmicrob.com date 09-07-2012 • www.jornalofhospitalinfection.com date 09-07- 2012 • CSSD of UP RIMS&R Saifai, Etawah