description about Hospital Infection, its causes, modes of transmission, prevebtion, diagnosis and treatment

1. DR VISHAL KULKARNI
MBBS MD (Microbiology)

2. Definition
‘Hospital infections’ OR ‘Hospital acquired
infections’ that develop in hospitalized patients,
which were not present or in incubation at the
time of their admission.
- also known as ‘Nosocomial infections’.
- may manifest during patient’s stay in hospital or
sometime after patient is discharged

3. Factors
predisposing
HAI
Hospital
pathogens
Immunocomp
romised state
Poor hygiene
Crowding
Instrumentati
ons
Extremes of
age
Implanted
prosthesis

4. Consequences of HAIs.
 Serious illhealth & death– increased morbidity &
mortality
 Need for additional antimicrobial therapy-
- ↑cost
- Drug toxicity.
- Drug resistance.
 Increased hospital stay--Economic loss

5. Microorganisms causing HAI
Gram negative> gram positive
Aerobic Bacteria-
- Staph. aureus
- Pseudomonas aeruginosa
- E. coli
- Klebsiella spp.
- Proteus spp.
- CONS
- Streptococcus spp.
- Serratia spp.
- salmonella, shigella, Mycobacterium spp.

6. Anaerobic bacteria-
- Bacterioides fragilis
- Clostrodium spp
- Propinibacterium spp.
Viruses-
- Hepatitis A, B, C, & D
- HSV
- CMV
- Enterovirus, Rotavirus, Rhinovirus
- HIV, RSV

7. Fungi-
- Candida spp
- Aspergillus spp
- Mucor spp
- Cryptococcus
- Histoplasma spp
Parasites-
- Entamoeba histolytica
- Toxoplasma gondii
- Acanthamoeba spp.

8. Sources of HAI
1.Endogeneous-
- Microorganisms normally present in OR on the body
of patients may act as opportunistic pathogens.
- ‘Endogenous infection’, ‘self infections’ OR
‘autoinfections’.
2. Exogenous-
A. Cross infections-
- infections from another patients or hospital staff to
susceptible individual.
B. Environmental infection-

9. B. Environmental infection
- Inanimate objects such as clothing, beddings etc.
- Wash bowls
- Dust
- IV fluid equipments.
- Surface contaminated with patients secretion, excretion.
- Urinals, bed pan etc
- Air
- Food

11. Different types of hospital infections
1. Urinary Tract infections-
- Constitute approximately 40% of HAI.
- a/w indwelling catheters OR Instrumentation.
- Colonization of drainage bag & retrograde flow in to
bladder (??)
- Manifest as pyelonephritis, cystitis, pyelitis or urethritis.
- E. coli, proteus spp., Pseudomonas aeruginosa, Klebsiella
spp., CONS

12. 2. Respitatory Tract Infections
- Constitute nearly 15-20% of infections.
- Ineffective cough & gag reflexes
- Impaired pulmonary clearance, cardiopulmonary diseases
- Use of resp. tract instrumentation, ventilation.
- Staph. aureus, Klebsiella spp, P. aeruginosa, E. coli, RSV,
Influenza virus.etc

13. 3. Wound & soft tissue infections.
- Post operative wound infections- incidence varies from 2% to 49%.
- Staph. Aureus, P. aeruginosa, E. coli. Klebsiella spp, proteus spp.
a. Surgical site infections-
- Intrabdominal & pelvic abscess surgery, infections after orthopedic, gynaec,
heart & urosurgery.
- Risk factors-( elderly, prolonged duration , immunocompromised,
contaminated & dirty types of surgery, skill of surgeon)
b. Nonsurgical
- Stitch abscess
- Umbilical stump
- Ulcers
- Burns
- Injection abscess

14. 4. Gastrointestina infections-
- Transmitted by ingestion of contaminated water or food
- Manifests as
- Diarrhoea
- Dysentery
- Enteric fever
- Food poisoning
5. Other infections
- Bacteremia
- Hepatitis
- Tuberculosis
- Tetanus

15. Lab diagnosis of HAI
 Aetiological diagnosis- smear, culture & identification.
 AST- multidrug resistance
 Outbreak-
 identification & elimination of the source
 sampling of various inanimate objects, hospital personnel,
patients.
 Water, food, air, blood products, disinfectants etc.
 Detection of carriers among staff & patients.
 Typing methods-
 Phage typing
 Bacteriocin typing
 Biotyping
 serotyping

16. Methods of prevention
Infection control aims to-
1. Reduce the microbial population of the hospital
environment.
2. Eliminate the danger of transmission of microrganisms
from one to another.
3. Manage linen, equipments & other inanimate objects.
Prevent them from becoming source of cross
contamination.

17. Standard precautions
1. Hand hygiene-
- Use of alcohol based hand rubs or soap & water.
- Before touching the patients even if with gloves.
- Before coming out from pt’s care area.
- Prior to contact with blood, body fluids or excretions.
- Prior to performing any aseptic task.e.g inserting IV line.
- After removal of gloves.
Ignaz Semmelweis

19. 2. Personal protective equipments-
- Wearable equipments intended to protect HCWs from
contacts with infectitious agents
- Gloves, gowns, face masks, respirators, goggels, face shields.
1. Gloves to be worn when there is possibility of contacts with
blood or body fluids, mucus memb.
2. Same pair of gloves should not be used for more than one
patients.
3. Should not be
washed & reused.

20. Other key recommendation-
- gown should be worn to protect skin & clothing whenever
contact is anticipated.
- Mouth, nose, eye protection during procedures likely to
generate splashes, sprays of blood.
- Surgical mask is worn when placing catheter, injecting
material into spinal canal.

21. 3. Injection safety.
- Aseptic technique
- Access diaphragms
of medication vials
cleaned with 70% alcohol.
- Same syringe should not be used for multiple patients, even
if needle is changed.
- Syringe should not reused to enter a vial or solution.
- Vials, ampoules, bags, bottles of IV soln. should not used to
more than one patients.

22. 4. Environmental cleaning-
- Removal of all visible soil & organic contamination from
device or environmental surfaces.
- Scrubbing with surfactants, detergents, ultrasonic cleaners.
- Disinfection is less lethal than sterilization.
5. Medical equipments.
- Single use & Reusable equipments (e.g. endoscopes,
glucometer etc)
- Reusables should be accompanied by instructions for
sterilization.

23. 5. Respiratory hygiene
- Any individual with cough, congestion, rhinorrhoea, RTI to
be promptly identified.
- Should be monitored throughout the duration of stay.
- Notices should be posted at entrances to cover their mouth/
noses.
Cover ur mouth & nose while sneezing

24. Precautions in operating theatre.
Conventional / plenum ventilation- 20 air
changes/hr
Laminar air flow- 300 air changes/hr
Bioloads-
bacteria
carrying
particles /m³
Conventional OTs Ultraclean OTs
For empty theaters- <35 Empty theaters- <1
During operation- <180 During operation-
<10

25. Hospital Infection Control Team
Effective HICT – microbiologists, medical & nursing
staff, hospital administrators & clinicians.

26. Functions of HICT-
 Organize surveillance programmes for various aspects of
infection.
 Investigations of possible source
 Site of occurrence
 Control of outbreak.
 Conduct training courses for staff
 Set & follow guidelines of admission, nursing &
treatment.
 Surveillance systems for sterilization, disinfection &
hygiene practices.
 Auditing of the various programmes undertaken by
HICT.

27.  Role of microbiologist-
 Diagnosis & susceptibility
testing of organisms
 Surveillance of infections.
 Notification of outbreaks.
 Investigation of source.
 Guidelines to control the infection.
 Timely reporting of data relevant to infection control.

28. Thank you…