Prevention of intrahospital infections Nosocomial infection It is

Prevention of intra-hospital infections

Nosocomial infection: It is an infection acquired in a medical setting in the course of medical treatment. It meets the following criteria: • 1 - Not found on admission • 2 – Temporally associated with admission or a procedure at a health-care facility • 3 – Was incubating at admission but related to a previous procedure or admission to same or other health-care facility.

Impact of nosocomial infection? • Increased morbidity (serious consequences and permanent disability ) • The length of hospital stay is prolonged, on average by 5– 10 days. • The risk of death approximately doubles in patients who acquire hospital infection. • Hospital-acquired infections are very expensive and contribute significantly to the escalating costs of health care. It has been argued that, even if moderately effective, a hospital infection control program is one of the most cost-effective and costbeneficial preventative medical interventions currently available.

Definition of Nosocomial infection The use of uniform definition is crucial if data from one hospital are to be compared with those of another hospital (interhospital) or with an aggregated database (intra-hospital). NI is a localized or systemic condition: 1 - that results from adverse reaction to the presence of an infectiuos agent(s) or its toxins and 2 - that was not present or incubating at the time of admission to the hospital. For most bacterial NI, it become evident 48 hours or more (typical incubation period) after admission. Because the incubation period varies with type of pathogen, and extent of the underlying condition, each infection should be assessed individually for evidence that links it to hospitalization.

Important principles upon which NI definitions are based First (available information): The information used to determine the presence and classification of an infection should be a combination of clinical findings, laboratory evidence and supportive data. Clinical evidence is derived from direct observation of the infection site or review of other pertinent sources of data such as the patient’s chart or medical record. Laboratory evidence includes results of cultures, antigens or antibody detection or microscopic examination. Supportive data are derived from other diagnostic studies such as: X-ray, US, CT, MRI, BAL, Endoscopy, . . etc

Second, (a physician’s or surgeon’s diagnosis) The diagnosis of infection by the surgeon or physician is derived from direct observation during a surgical operation, endoscopic examination or other diagnostic study or from clinical judgment. This diagnosis could be an acceptable criterion for an infection unless there is compelling evidence to the contrary. For certain sites of infections, however, a physician’s clinical diagnosis in the absence of supportive data must be accompanied by initiation of appropriate or empirical antimicrobial therapy to satisfy the criterion.

Goals for infection control and hospital epidemiology There are three principal goals for hospital infection control and prevention programs: 1. Protect the patients 2. Protect the health care workers, visitors, and others in the healthcare environment. 3. Accomplish the previous two goals in a cost effective and cost efficient manner, whenever possible.

Most Common Types of Nosocomial Infections • These are infections that develop during hospitalization and are present in patients at the time of admission. • Most Common Types of Nosocomial Infections: 1. Urinary tract infections. 2. Surgical wound infections. 3. Lower respiratory Tract infections (primarily pneumonia). 4. Bloodstream infections (septicaemia) Nabeel Al-Mawajdeh RN. MCS

Modes of Transmission of Infections 1. Contact: - Direct e. g. , hands of hospital personnel. - Indirect e. g. , using contaminated objects. 2. Contaminated vehicles used in common for patients e. g. , instruments, contaminated food, water, solutions, drugs or blood products. 3. Airborne e. g. , aerosol, droplets or dust. 4. Vector borne: e. g. , mosquitoes. 5. Blood borne: inoculation injury or sexual transmission e. g. , HBV, HIV.

Patients Most Likely to Develop Nosocomial Infections 1. 2. 3. 4. 5. 6. Elderly patients. Women in labor and delivery. Premature infants and newborns. Surgical and burn patients. Diabetic and cancer patients. Patients receiving treatment with steroids, anticancer drugs, antilymphocyte serum, and radiation. Nabeel Al-Mawajdeh RN. MCS

Patients Most Likely to Develop Nosocomial Infections (Cont’d) 7. 8. Immunosupressed patients (I. e. , patients whose immune systems are not functioning properly) Patients who are paralyzed or are undergoing renal dialysis or catheterization; quite often, these patient’s normal defence mechanisms are not functioning properly) Nabeel Al-Mawajdeh RN. MCS

Major Factors Contributing to Nosocomial Infections 1. 2. 3. 4. 5. An ever- increasing number of drug-resistant pathogens. Lack of awareness of routine infection control measures. Neglect of aseptic techniques and safety precautions. Lengthy complicated surgeries. Overcrowding of hospitals. Nabeel Al-Mawajdeh RN. MCS

Major Factors Contributing to Nosocomial Infections (Cont’d) 6. 7. 8. Shortage of hospital staff. An increased number of Immunosupressed patients. The overuse and improper use of indwelling medical devices. Nabeel Al-Mawajdeh RN. MCS

Prevention of Nosocomial Infections 1. Education of hospital staff in: - Hygiene in theatre, wards, kitchen…etc. - Good surgical techniques. - Frequent handwashing. 2. Proper sterilization and disinfection. 3. Special precautions and isolation of infective patients. Nabeel Al-Mawajdeh RN. MCS

Prevention of Nosocomial Infections (Cont’d) 4. 5. 6. Protective precautions for high risk patients, e. g. , Immunosupressed. Conservative antibiotic use. Surveillance of infections in the hospital by infection control staff. Nabeel Al-Mawajdeh RN. MCS

SOURCES: 1. Patients own flora - Endogenous (50%) Auto-Infection ( Greatest source of potential danger) 2. Environment - Exogenous(15%) (Air-5%; Instruments-10%) 3. Another Patient/Staff - Cross Infection (35%)

METHICILLIN RESISTANT STAPH AUREUS (MRSA) Resistant to Flucoxacillin and usually others May cause Wound infection Bacteraemia Skin/soft tissue infection U. T. I. Pneumonia etc.

Colonisation common: Nose Axilla Perineum Wounds/Lesions Spread By: Hands Fomites Aerosols Becoming more common in the Community Control: Eradication of carriage Barrier nursing Screening of other patients Staff

RESISTANT GRAM NEGATIVE ORGANISMS Resistance to multiple antibiotics Organisms: E. coli Proteus Enterobacter Acinetobacter Pseudomonas aeruginosa

Cause: Bacteraemia U. T. I. Pneumonia Wound infection Control: Antibiotic Policy Control of Infection Guidelines Prevention of Cross Infection especially on high risk areas

GENERAL PRINCIPLES Good general ward hygiene: - No overcrowding - Good ventilation - Regular removal of dust - Wound dressing early in day - Disposable equipment HAND WASHING most important Before and after patient contact before invasive procedures

Hospitalism Be are what physical, psychical, infectious disorders of health of man, conditioned the features of medical service.

Hospitalism Physical Accident Psychical Hospital infection Hospital cultures are adapted sporadic Hospital cultures are no adapted endemic epidemic

Intrhospital (nosocomial, hospital) infection • any clinically recognized disease of microbial etiology is related to the stay, treatment, inspection or appeal of man for medical help in hospital.

Exciters of intrahospital (nosocomial, hospital) infections – Staphylococcus, streptococci, blue pear stick, coli bacillus, salmonella, enter bacteria, enter cocas and other de bane ease pathogenic microorganisms. – And also viruses of flu, adenovirus, enter virus, exciters of viral hepatitis ESCHERICHIA COLI

Distribution of certain exciter in development of infection can be related to the type of medical establishment • In permanent establishments of general surgical type are gram-negative bacteria, in particular blue pear • in urology separations is a coli bacillus, enter cocas and others like that. ESCHERICHIA COLI

Distribution of certain exciter in development of infection can be related to the type of medical establishment • Blue pear sticks prevail in separations. • in separations new-born find staphylococcus, enter cocas. STAPHYLOCOCCUS AUREUS

Sources of infection: • • • patients personnel visitors apparatus instruments linen et cetera Patients can be infected pathogenic factors both from an external environment and own in the case of hyposthenic immunity

Ways of infection`s patients • air-dust borne; • - (through the articles of examination, linen, medical instruments, apparatus, hands of medical personnel); • - (at introduction of medicinal preparations, solutions and others like that); • -alimentary (products, water and others like that).

Ways of transfer of intrahospital infections PATIENT Objects materials animals and others like that Personnel visitors patients

Except for control after the observance of sanitary-hygienic requirements in relation to apartments, personal hygiene it is necessary to conduct: - timely exposure and sanation of transmitters of pathogenic staphylococcus: one time in a quarter obligatory inspection of employees on the transmitter of pathogenic staphylococcus for the medical staff of surgical separations and maternity

• - safety measures at AIDS and disease mode, measures of infection; • - observance of rules of asepsis and antiseptic;

Prophylaxis of in-hospital infections Technical measures Sanitary disease measures Disinfection and sterilization IMMUNISATION Emergency Architectonically plan measures Specific prophylaxis Planned Un specific prophylaxis

Measures of architectural plan A rational location of separations is on floors Isolation of sections, chambers, operating blocks but other Observance of streams sick, personnel Zoning of territory

Technical measures Ventilation: (reveal, drawing, mixed, condition)

Sanitary disease measures Sanitary educational work is among a personnel and patients Control is after the sanitary state and mode of permanent establishments An exposure of transmitters is among a personnel and patients Control is after the bacterial semi nation of in-hospital environment

Disinfection and sterilization measures Tooling Use chemical facilities Use physical methods д

Contact Precautions PPE Ш Gown and gloves Ш Don upon entry to room Ш Remove and discard before leaving the room Ш Perform hand hygiene after removal • Environmental measures/patient care equipment – Clean patient room daily using a hospital disinfectant, with attention to frequently touched surfaces (bed rails, bedside tables, lavatory surfaces, blood pressure cuff, equipment surfaces). – Use dedicated equipment if possible (e. g. , stethoscopes, bp cuffs)

Droplet Precautions • Patient placement – Single room or cohort with patients with same infection – If neither is possible, ensure patients are separated by at least 3 ft (1 meter) – Surgical mask on patient when outside of patient room – Negative pressure or airborne isolation rooms not required PPE • surgical mask • Don upon entry into room • Eye protection (goggles or face shield) if needed according to standard precautions