Hospital Infections

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HOSPITAL INFECTIONS Concerns and Prevention Dr.T.V.Rao MD Dr.T.V.Rao MD' TMC Kollam Kerala 1

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A Tribute to Ignaz Semmelweiss (1818-1865) Ignaz Semmelweiss (1818-1865) Obstetrician, practised in Vienna Studied puerperal (childbed) fever Established that high maternal mortality was due to failure of doctors to wash hands after post-mortems Reduced maternal mortality by 90% Ignored and ridiculed by colleagues Dr.T.V.Rao MD' TMC Kollam Kerala 2

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Hospital Infection Hospital infection is also called Nosocomial infection. It is the single largest factor that adversely affects both the patient and the hospital Dr.T.V.Rao MD' TMC Kollam Kerala 3

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What is Hospital Acquired Infections Any infection that is not present or incubating at the time the patient is admitted to the hospital Dr.T.V.Rao MD' TMC Kollam Kerala 4

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Why is infection such a problem even after 100 years since Lister and Pasteur ? 1. Advancing age of the patients, as they are more prone to infection. 2. Use of sophisticated and complicated equipment which is not easy to clean, disinfect or sterilize. 3. Increasing specialization bringing together patients susceptible to some type of infection. Dr.T.V.Rao MD' TMC Kollam Kerala 5

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Increasing trends 4. Increased use and empirical use of antibiotics resulting in drug resistance. 5. Higher rate of staff turnover makes it difficult to maintain uniform standards 6. Effective sterilization system as yet not fully understood by all concerned. Dr.T.V.Rao MD' TMC Kollam Kerala 6

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Additional morbidity Prolonged hospitalization Long-term physical, developmental and neurological sequelae Increased cost of hospitalization Death Dr.T.V.Rao MD' TMC Kollam Kerala 7 Consequences of Hospital Acquired Infections

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Why Everyone Concerned with Hospital Infections The Centers for Disease Control (CDC) estimates that 2 million U.S. patients a year acquire hospital-related infections. Dr.T.V.Rao MD' TMC Kollam Kerala 8

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The nature of infections Micro-organisms - bacteria, fungi, viruses, protozoa and worms Most are harmless [non-pathogenic] Pathogenic organisms can cause infection Infection exists when pathogenic organisms enter the body, reproduce and cause disease Dr.T.V.Rao MD' TMC Kollam Kerala 9

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HAI - common bacteria Staphylococci - wound, respiratory and gastro-intestinal infections Escherichia coli - wound and urinary tract infections Salmonella - food poisoning Streptococci - wound, throat and urinary tract infections Proteus - wound and urinary tract infections (Peto, 1998) C.difficle an emerging pathogen Dr.T.V.Rao MD' TMC Kollam Kerala 10

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HAI - common viruses Hepatitis A - infectious hepatitis Hepatitis B - serum hepatitis Human immunodeficiency virus [HIV] - acquired immunodeficiency syndrome [AIDS] (Peto, 1998) Dr.T.V.Rao MD' TMC Kollam Kerala 11

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What is Infection Control Infection control is the discipline concerned with preventing nosocomial or healthcare-associated infection. As such, it is a practical (rather than an academic) sub-discipline of epidemiology. It is an essential (though often under-recognized and under-supported) part of the infrastructure of health care. Dr.T.V.Rao MD' TMC Kollam Kerala 12

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Beginning of Hospital Infection Programme Modern hospital infection control programs first began in the 1950s in England, where the primary focus of these programs was to prevent and control hospital-acquired staphylococcal outbreaks. In 1968, the American Hospital Association published "Infection Control in the Hospital," Dr.T.V.Rao MD' TMC Kollam Kerala 13

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First Data on Infection Control Efficacy In 1985, the Study of the Efficacy of Nosocomial Infection Control (SENIC) project was published, validating the cost-benefit of infection control programs. Data collected in 1970 and 1976-1977 suggested that one-third of all nosocomial infections could be prevented Dr.T.V.Rao MD' TMC Kollam Kerala 14

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Joint Commission on Accreditation of Healthcare Organizations (JCAHO) In 1969, the Joint Commission for Accreditation of Hospitals--later to become the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)--first required hospitals to have organized infection control committees and isolation facilities Dr.T.V.Rao MD' TMC Kollam Kerala 15

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Beginning of AIDS Pandemic Necceciates Stronger Infection Control Protocols The second and certainly most significant factor influencing infection control at the time was the advent of acquired immunodeficiency syndrome (AIDS). HIV has been a challenge for education, risk reduction and resource utilization. Dr.T.V.Rao MD' TMC Kollam Kerala 16

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Infection Control Challenges of Healthcare in 2000 Decreasing reimbursement Increasing emerging infections Increasing resistant organisms Increasing drug costs Nursing shortage OSHA safety legislations Multiple benchmark systems FDA legislation on reuse of single-use devices Dr.T.V.Rao MD' TMC Kollam Kerala 17

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Infection control was influenced by the reform of the Healthcare System Infection control programs had to encompass not only hospitals but also the long-term care facility, home health/hospice, rehabilitation facilities, free-standing surgical centers, and physician office practices. A dramatic shift in patient care practices occurred as greater than 65% of surgery cases were operated on in an outpatient setting. Dr.T.V.Rao MD' TMC Kollam Kerala 18

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19 Identify problems with polices and procedures Example: Pre- and Post-Operative Care create your protocols Skin shaved the night before surgery Inappropriate peri-op antibiotic prophylaxis Instruments used for dressing changes submerged disinfectant Large containers of antiseptics, no routine for cleaning and refilling Eliminate shaving of skin the night before surgery Single dose peri-op antibiotic prophylaxis guidelines Use individual sterile packs of wound care instruments Use small containers of antiseptics; clean and dry containers before refilling Recommendation Problem Area Dr.T.V.Rao MD' TMC Kollam Kerala

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Challenging Issues Issues that will continue to impact infection control programs into the new millennium are a challenging combination of cost and clinical factors and increasing cost to treat infections, and financial impact of implementing new government regulations . Dr.T.V.Rao MD' TMC Kollam Kerala 20

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Infection Control Committee and Antibiotic Policies are Back bone for reduction of Infections Dr.T.V.Rao MD' TMC Kollam Kerala 21

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Your Unwashed Hand a Great Concern to Your Patient Dr.T.V.Rao MD' TMC Kollam Kerala 22

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GUIDELINES AND RECOMMENDATIONS Hand washing and Hospital Environmental Control * Immunization * Infectious Diseases Control * Intravascular Device-Related Infections and its control * Isolation Precautions Dr.T.V.Rao MD' TMC Kollam Kerala 23

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Scientific Disinfection Practices Saves Several Lives *Long-Term Care Facilities *Guidelines for Infection Control in Health Care Personnel * Surgical Site Infections Control * Urinary Tract and Respiratory Tract Infections Control * Ordering and Preparing Guidelines appropriately * Home care * Hospital Construction * Sterilization / Disinfection Dr.T.V.Rao MD' TMC Kollam Kerala 24

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Protecting Yourself from Blood-Borne Pathogens Dr.T.V.Rao MD' TMC Kollam Kerala

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HIV: 3 Infections per 1,000 Sticks with a HIV+ Needle 000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000 Dr.T.V.Rao MD' TMC Kollam Kerala

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Hepatitis C: 18 Persons per 1,000 Needle-sticks 000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000 Dr.T.V.Rao MD' TMC Kollam Kerala

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Hepatitis B is Most Infectious 0000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000 Dr.T.V.Rao MD' TMC Kollam Kerala

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Safe Handling of Sharps Wear gloves when drawing blood or handling sharps—double glove for surgery Don’t recap! Don’t bend or break needles Never place used sharps on tables, beds, furniture Put used sharps immediately into a sharps container Dr.T.V.Rao MD' TMC Kollam Kerala 29

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30 Infection Control Committee - Represented Committee Representatives Hospital Epidemiologist Infection Control Practitioners Administrator Ward, ICU and Operating room Nurses Medicine/Surgery/Obstetrics/Pediatrics Central Sterilization Hospital Engineer Microbiologist Pharmacist Dr.T.V.Rao MD' TMC Kollam Kerala

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Hand Washing is the Foundation of Infection Control Hand washing is the single most important procedure for preventing nosocomial infections.. Although various products are available, hand washing can be classified simply by the nature of the products used: plain soap detergents Antimicrobial containing products Dr.T.V.Rao MD' TMC Kollam Kerala 31

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Successful Promotion in Hand Washing ? Education Routine observation & feedback Engineering controls Location of hand basins Possible, easy & convenient Alcohol-based hand rubs available Patient education (Improving Compliance with Hand Hygiene in Hospitals. Didier Pittet. Infection Control and Hospital Epidemiology. Vol. 21 No. 6 Page 381) Dr.T.V.Rao MD' TMC Kollam Kerala 32

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Successful Promotion Can Improve Hand Washing ? Reminders in the workplace Administrative sanctions ?? Promote and facilitate skin care Avoid understaffing and excessive workload Dr.T.V.Rao MD' TMC Kollam Kerala 33

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Computerized Surveillance Surveillance traditionally involved significant manual data assessment Increasingly, integrated computerized software solutions are becoming available that assess incoming risk messages from microbiology and other online sources. Dr.T.V.Rao MD' TMC Kollam Kerala 34

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Formulating an Infection Control Plan Every infection control program should develop a well-defined written plan outlining the organizational philosophy regarding infection prevention and control. The plan should take into account the goals, mission statement, and an assessment of the infection control program. Dr.T.V.Rao MD' TMC Kollam Kerala 35

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Infection Control Programme and Documentation Goals of the infection control program need to be incorporated into the mission statement of the facility. A mission statement should tell who you are, what you do, and should communicate a clear view of purpose and set a strategy for accomplishing the goal Dr.T.V.Rao MD' TMC Kollam Kerala 36

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Waste disposal Clinical waste - HIGH risk potentially/actually contaminated waste including body fluids and human tissue yellow plastic sack, tied prior to incineration Household waste - LOW risk paper towels, packaging, dead flowers, other waste which is not dangerously contaminated black plastic sack, tied prior to incineration Follow local policy (May, 2000) Dr.T.V.Rao MD' TMC Kollam Kerala 37

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Document Antibiograms With WHONET WHONET is a free Windows-based database software developed for the management and analysis of microbiology laboratory data with a special focus on the analysis of antimicrobial susceptibility test results. Dr.T.V.Rao MD' TMC Kollam Kerala 38

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Health Care Means In patient care and outpatient care Significant trends in healthcare are occurring everyday including new medical procedures (i.e., gene therapy, Stem cell therapy), new technology (multi-purpose intravenous catheters), and a shift from inpatient to outpatient care. Dr.T.V.Rao MD' TMC Kollam Kerala 39

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Surveillance The key to ongoing monitoring is surveillance for nosocomial infections. Various techniques for surveillance have been described and evaluated including total house surveillance, targeted surveillance, Kardex, or laboratory-base Dr.T.V.Rao MD' TMC Kollam Kerala 40

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What we need and what to do One infection control professional (ICP) for every 250 beds. An effective infection control physician. A program reporting infection rates back to the surgeon and those clinically involved with the infection. An organized hospital-wide surveillance system. Dr.T.V.Rao MD' TMC Kollam Kerala 41

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Hospital Infections
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