HEALTHCARE-ASSOCIATED HEALTHCARE-ASSOCIATED INFECTIONS: INFECTIONS: Epidemiology and Epidemiology and Principles Principles
HEALTHCARE-ASSOCIATED HEALTHCARE-ASSOCIATED INFECTIONS: INFECTIONS:
Epidemiology and PrinciplesEpidemiology and Principles
INFECTIONINFECTION““the state or condition in which the the state or condition in which the body or part of the body is invaded body or part of the body is invaded
by a pathogenic agent (bacteria, by a pathogenic agent (bacteria, virus, parasites etc.) which under virus, parasites etc.) which under
favorable conditions multiplies and favorable conditions multiplies and produces effects which are produces effects which are
injurious...”injurious...”
Nosocomial InfectionNosocomial Infection
• ““hospital acquired “ hospital acquired “
• ““hospital-associated”hospital-associated”
• ““healthcare-associated”healthcare-associated”
• infections that are caused infections that are caused by microorganisms and by microorganisms and acquired within the acquired within the healthcare facilityhealthcare facility
Nosocomial InfectionNosocomial Infection
Infection acquired 48 hoursInfection acquired 48 hours
after admission to hospitalafter admission to hospital• should not be present on
admission• acquired while in the
healthcare facility• May manifest after
discharge
Types of Nosocomial Types of Nosocomial InfectionInfection
UrinaryUrinary RespiratoryRespiratory GastrointestinalGastrointestinal Blood streamBlood stream Skin, Wound, BurnSkin, Wound, Burn Surgical wound infectionSurgical wound infection OthersOthers
Healthcare-associated InfectionsHealthcare-associated Infections
PREVALENCE / PREVALENCE / INCIDENCEINCIDENCE
< 5% - > 50%< 5% - > 50%
Infection ControlRate in Philippine
Hospitals
Pooled Cumulative Incidence Density Of HCAI And Device-associated Infection In Adult ICU Patients In
High-, Middle- And Low-income Countries
Burden of Endemic Health Care-Associated Infections, A systematic review of the literature, WHO Report 2011
2.5x higher
Comparison of Local and International HCAI Data
SHIP NHSN INICC
FC-UTI 1.91 3.4 6.1
CL Associated Bloodstream Infection
2.76 1.5 7.4
Ventilator Associated Pneumonia
11.2 2.2 14.7
SHIP - Surveillance of Hospital Acquired Infection in the Philippines, Philippine Hospital Infection Control Society, Inc.NHSN - Hational Healthcare Safety Network, CDC, USAINICC - International Nosocomial Infection Control Consortium, Dr David Rosenthal
Hospital Wide Surveillance Component Hospital Wide Surveillance Component and Medians of Hospital Overall Rateand Medians of Hospital Overall Rate
RATE
3.5
5.16.4 6.4
0.9 0.4
14
0.4
0
2
4
6
8
10
12
14
RATE
MedicineBurn TraumaGen. Surg.NeurosurgeryObstetricsPediatricsHigh risk nurseryWell baby nursery
Distribution of Major Infection Sites from all Distribution of Major Infection Sites from all patients and Major services, Hospital-Wide patients and Major services, Hospital-Wide
Component, NNIS System Component, NNIS System
Infection
ALL PERCENT OF CASES
TYPE HOSPITAL General Surgery
N=26,408
Medical
N=26,178
Newborn
N=3,220 UTI 33.1 30.2 42.1 4.2
Pneumonia 15.5 16.4 17.0 14.9
SSI 14.8 24.5 2.3 1.8
Others 23.4 19.4 23.8 43.1
Distribution of Major Infection Sites from all Distribution of Major Infection Sites from all patients and Major services, Hospital-Wide patients and Major services, Hospital-Wide
Component, NNIS System Component, NNIS System
Infection
ALL PERCENT OF CASES
TYPE HOSPITAL OB N=2,931
Gynecology N=1,882
Pediatric N=1,586
UTI 33.1 16.5 39.7 12.7
Pneumonia 15.5 2.3 6.5 12.7
SSI 14.8 45.0 37.2 6.1
Primary SSI
13.1 2.2 3.9 29.7
Others 23.4 34.0 12.7 38.8
Factors Promoting Factors Promoting Nosocomial InfectionNosocomial Infection
AgeAge Duration of hospitalizationDuration of hospitalization Surgery (type of operation)Surgery (type of operation) Immune status: chemotherapy, radiation therapy, Immune status: chemotherapy, radiation therapy,
malignancymalignancy Diagnostic technique and proceduresDiagnostic technique and procedures EnvironmentEnvironment PersonnelPersonnel PatientPatient OthersOthers
The “C ST” of The “C ST” of Hospital-Acquired InfectionHospital-Acquired Infection
PERSONNELPERSONNEL
Hospitalization, etc.Hospitalization, etc.
Income lossIncome loss
Repeat hospitalizationRepeat hospitalization
DisfigurementDisfigurement
DisabilityDisability
Pain, suffering etc.Pain, suffering etc.
DeathDeath
The “C ST” of The “C ST” of Hospital-Acquired InfectionHospital-Acquired Infection
INSTITUTIONSINSTITUTIONS
Loss of RevenueLoss of Revenue
Extra duty and Time CostsExtra duty and Time Costs
Liability InsuranceLiability Insurance
MalpracticeMalpractice
ReputationReputation
The “C ST” of The “C ST” of Hospital-Acquired InfectionHospital-Acquired Infection
NationalNational
PatientsPatients
InfectionsInfections
Days in HospitalDays in Hospital
COSTCOST
The “C ST” of The “C ST” of Hospital-Acquired InfectionHospital-Acquired Infection5-10% incidence of nosocomial 5-10% incidence of nosocomial
infectioninfection$550.00 average cost per infection $550.00 average cost per infection
(USA)(USA)7.4 average extra days in hospital7.4 average extra days in hospital$600-$2,000 extra direct hospital $600-$2,000 extra direct hospital
costcost
How do infections occur in How do infections occur in the Hospital Setting ?the Hospital Setting ?
How do Infections occur in How do Infections occur in Hospital Setting ?Hospital Setting ?
SOURCE/SOURCE/AGENTAGENT
SusceptibleSusceptibleHOSTHOST
Environment/Environment/Means ofMeans of
TransmissionTransmission
Sources of InfectionSources of Infection
EXOGENOUSEXOGENOUS• HandsHands• InstrumentsInstruments• CathetersCatheters• Respiratory equipmentRespiratory equipment• TransfusionsTransfusions• IV systemIV system• LinenLinen• AirAir
EndogenousEndogenousSources of InfectionSources of Infection
Oro - PharynxOro - PharynxRespiratoryRespiratory
GastrointestinalGastrointestinalS K I NS K I N
Causative AgentsCausative Agents
GRAM NEGATIVERODS
GRAM POSITIVECOCCI
OTHERS
Escherichia coli Staphylococcusaureus
Fungi -Candida sp.;Aspergillus sp.
Klebsiella sp. Staphylococcusepidermidis
Protozoans
Pseudomonasaeruginosa
Enterococci Mycobacteriumtuberculosis
Acinetobacter sp. Pneumocystiscarinii
Enterobacter sp. Anaerobes
Factors Promoting Factors Promoting Endogenous InfectionEndogenous Infection
OperationsOperations CathetersCatheters Foreign bodiesForeign bodies ChemotherapyChemotherapy Immuno- Immuno-
suppressionsuppression Pre-existingPre-existing
diseasedisease
SOURCEMeans of
TransmissionSusceptible
Host
AnimateAnimateInanimateInanimate
CONTACTCONTACT• DirectDirect• IndirectIndirect• DropletDropletAIRBORNEAIRBORNEVEHICLEVEHICLEVECTORVECTOR
DiseaseDisease
TherapyTherapy
Natural Natural ConditionsConditions
SOURCE OF INFECTIONSOURCE OF INFECTION
What is the degree of contamination in What is the degree of contamination in the person or object ?the person or object ?
What is the virulence of the organism ?What is the virulence of the organism ? What conditions are present in the object What conditions are present in the object
or person that favor survival and growth or person that favor survival and growth of microorganisms ?of microorganisms ?
What kind of contact will the object or What kind of contact will the object or person have with the potential host ? person have with the potential host ?
SOURCE OF INFECTIONSOURCE OF INFECTION
What is the degree of contaminationWhat is the degree of contamination
in the person or object ?in the person or object ?
““contamination is heavier with wet contamination is heavier with wet objects that dry objects...”objects that dry objects...”
SOURCE OF INFECTIONSOURCE OF INFECTION
What is the virulence of the What is the virulence of the organism ?organism ?
““As a general rule: the MORE virulent As a general rule: the MORE virulent the organisms, the LESS the number the organisms, the LESS the number
needed to produce the disease...”needed to produce the disease...”
SOURCE OF INFECTIONSOURCE OF INFECTION
What conditions are present in the object What conditions are present in the object or person that favor survival and growth or person that favor survival and growth of microorganisms ?of microorganisms ?
SOURCE OF INFECTIONSOURCE OF INFECTION
What kind of exposure will What kind of exposure will the object or person have the object or person have with the potential host ?with the potential host ?
MEANS OF TRANSMISSIONMEANS OF TRANSMISSION
CONTACTCONTACT DROPLETDROPLET AIRBORNEAIRBORNE VEHICLEVEHICLE VECTOR VECTOR
Means of TransmissionsMeans of Transmissions
CONTACT CONTACT - direct or indirect- direct or indirect
DROPLETDROPLET - > 5um- > 5um
AIRBORNEAIRBORNE- droplet nuclei; residue - droplet nuclei; residue
from evaporated dropletsfrom evaporated droplets
VECTORVECTOR - insects or animals - insects or animals
VEHICLEVEHICLE - food, water, blood, - food, water, blood,
medicationmedication
Means of TransmissionsMeans of TransmissionsCONTACTCONTACT- most common means of transmitting - most common means of transmitting
microorganisms from one person to anothermicroorganisms from one person to another
A. Direct ContactA. Direct Contact
- occurs when one person touches another- occurs when one person touches another
- direct contact is an ongoing process in the- direct contact is an ongoing process in the
hospitalhospital
- best vehicle : Hands- best vehicle : Hands
B. Indirect ContactB. Indirect Contact
- occurs when a person touches an inanimate- occurs when a person touches an inanimate
object contaminated by an infected patientobject contaminated by an infected patient
SUSCEPTIBLE HOSTSUSCEPTIBLE HOST
Factors that alter Host Factors that alter Host SusceptibilitySusceptibility
Chronic underlying diseasesChronic underlying diseases Immune deficiency statesImmune deficiency states MalignanciesMalignancies
Therapeutic measuresTherapeutic measures ImmunosuppressionImmunosuppression Antibiotic therapyAntibiotic therapy
Insertion or application of devicesInsertion or application of devices SurgerySurgery AGEAGE
SOURCEMeans of
TransmissionSusceptible
Host
AnimateAnimateInanimateInanimate
CONTACTCONTACT• DirectDirect• IndirectIndirect• DropletDropletAIRBORNEAIRBORNEVEHICLEVEHICLEVECTORVECTOR
DiseaseDisease
TherapyTherapy
Natural Natural ConditionsConditions
SOURCESOURCE
SusceptibleSusceptibleHOSTHOST
Means ofMeans ofTransmissionTransmission
INFECTIONINFECTION
ISOLATION TECHNIQUEAnimal and Insect Control
Nursing and Medical
Management
Infection Control Policies and Procedures
Patient CareHandling of supplies
and equipment
Improvement of Improvement of Host ResistanceHost Resistance
Decreasing the contact of the Decreasing the contact of the immunocompromised host to immunocompromised host to potential pathogens through potential pathogens through protective or reverse isolation protective or reverse isolation methodsmethods
Improvement of Improvement of Host ResistanceHost Resistance
Avoiding or Avoiding or removing factors that removing factors that impair host defenses. impair host defenses. Invasive devices Invasive devices should be avoided or should be avoided or should be removed should be removed as soon as possible. as soon as possible.
Improvement of Improvement of Host ResistanceHost Resistance
Immunotherapy, immunizations and Immunotherapy, immunizations and other methods of reconstituting other methods of reconstituting patients’ immune response maybe patients’ immune response maybe attemptedattempted
Improvement of Improvement of Host ResistanceHost Resistance
Early recognition and treatment of Early recognition and treatment of infections, and the utilization of infections, and the utilization of ancillary measures such as exercise ancillary measures such as exercise therapy to hasten recovery of therapy to hasten recovery of patientspatients
SOURCESOURCE
SusceptibleSusceptibleHOSTHOST
Means ofMeans ofTransmissionTransmission
INFECTIONINFECTION
ISOLATION TECHNIQUEAnimal and Insect Control
Nursing and Medical
Management
Infection Control Policies and Procedures
Patient CareHandling of supplies
and equipment
Minimizing the Minimizing the RISK of INFECTIONRISK of INFECTION
• The environment should be HOSTILE The environment should be HOSTILE to the multiplication of pathogens to the multiplication of pathogens i.e. clean, dry and well ventilatedi.e. clean, dry and well ventilated
Minimizing the Minimizing the RISK of INFECTIONRISK of INFECTION
• All instruments and equipment All instruments and equipment should be clean and dry.should be clean and dry.
• Invasive items should be sterilized Invasive items should be sterilized and items in contact with mucous and items in contact with mucous membranes, body fluids and membranes, body fluids and potentially infectious materials potentially infectious materials should be disinfected.should be disinfected.
Minimizing the Minimizing the RISK of INFECTIONRISK of INFECTION
• The hands should be washed after The hands should be washed after handling infectious materials (e.g. handling infectious materials (e.g. bed linen, dressings, secretion and bed linen, dressings, secretion and excretions) and before aseptic or excretions) and before aseptic or surgical procedures. surgical procedures.
• The skin of the patient should be The skin of the patient should be disinfected before invasive disinfected before invasive procedures.procedures.
Minimizing the Minimizing the RISK of INFECTIONRISK of INFECTION
• Emphasize Emphasize HANDWASHINGHANDWASHING for for personal hygienepersonal hygiene
Minimizing the Minimizing the RISK of INFECTIONRISK of INFECTION
• All infectious materials (e.g. linen, All infectious materials (e.g. linen, clinical waste, sharps) should be clinical waste, sharps) should be safely contained, decontaminated or safely contained, decontaminated or destroyeddestroyed
Minimizing the Minimizing the RISK of INFECTIONRISK of INFECTION
• Food should be hygienically Food should be hygienically prepared, properly cooked and prepared, properly cooked and stored at low temperatures until usedstored at low temperatures until used
Minimizing the Minimizing the RISK of INFECTIONRISK of INFECTION
• Susceptible patients or sites should be Susceptible patients or sites should be protected from pathogenic protected from pathogenic microorganisms: i.e. dressing, isolation, microorganisms: i.e. dressing, isolation, barrier, nursingbarrier, nursing
• The resistance of susceptible host should The resistance of susceptible host should be enhanced when possible: vaccination, be enhanced when possible: vaccination, immunization and sometimes prophylactic immunization and sometimes prophylactic
antibiotics should be used antibiotics should be used
Control Measures for Healthcare-Control Measures for Healthcare-Associated InfectionAssociated Infection
Infection control measuresInfection control measuresChemoprophylaxisChemoprophylaxis ImmunoprophylaxisImmunoprophylaxisTherapyTherapyEmployee Health ProgramEmployee Health Program
SOURCESOURCE
SusceptibleSusceptibleHOSTHOST
Means ofMeans ofTransmissionTransmission
INFECTIONINFECTION
ISOLATION TECHNIQUEAnimal and Insect Control
Nursing and Medical
Management
Infection Control Policies and Procedures
Patient CareHandling of supplies
and equipment
Control Measures for Control Measures for Nosocomial InfectionNosocomial Infection
InfectionInfectionControl Control MeasuresMeasures
InfectionInfectionControl Control MeasuresMeasures
CHEMO-CHEMO-PROPHYPROPHYLAXISLAXIS
CHEMO-CHEMO-PROPHYPROPHYLAXISLAXIS
IMMUNO-IMMUNO-PROPHYPROPHYLAXISLAXIS
IMMUNO-IMMUNO-PROPHYPROPHYLAXISLAXIS
THERAPYTHERAPYTHERAPYTHERAPYEmployeeEmployee
HealthHealthProgramProgram
EmployeeEmployeeHealthHealth
ProgramProgram
Standard PrecautionsStandard PrecautionsBarrier PrecautionsBarrier PrecautionsIsolation PrecautionsIsolation PrecautionsSterilizationSterilizationDisinfectionDisinfectionEnvironmental SanitationEnvironmental Sanitation
Standard PrecautionsStandard PrecautionsBarrier PrecautionsBarrier PrecautionsIsolation PrecautionsIsolation PrecautionsSterilizationSterilizationDisinfectionDisinfectionEnvironmental SanitationEnvironmental Sanitation
Control Measures for Control Measures for Nosocomial InfectionNosocomial Infection
InfectionInfectionControl Control MeasuresMeasures
InfectionInfectionControl Control MeasuresMeasures
CHEMO-CHEMO-PROPHYPROPHYLAXISLAXIS
CHEMO-CHEMO-PROPHYPROPHYLAXISLAXIS
IMMUNO-IMMUNO-PROPHYPROPHYLAXISLAXIS
IMMUNO-IMMUNO-PROPHYPROPHYLAXISLAXIS
THERAPYTHERAPYTHERAPYTHERAPYEmployeeEmployee
HealthHealthProgramProgram
EmployeeEmployeeHealthHealth
ProgramProgram
SURGICALSURGICALNON-SURGICALNON-SURGICAL
SURGICALSURGICALNON-SURGICALNON-SURGICAL
Control Measures for Control Measures for Nosocomial InfectionNosocomial Infection
InfectionInfectionControl Control MeasuresMeasures
InfectionInfectionControl Control MeasuresMeasures
CHEMO-CHEMO-PROPHYPROPHYLAXISLAXIS
CHEMO-CHEMO-PROPHYPROPHYLAXISLAXIS
IMMUNO-IMMUNO-PROPHYPROPHYLAXISLAXIS
IMMUNO-IMMUNO-PROPHYPROPHYLAXISLAXIS
THERAPYTHERAPYTHERAPYTHERAPYEmployeeEmployee
HealthHealthProgramProgram
EmployeeEmployeeHealthHealth
ProgramProgram
ACTIVE IMMUNIZATIONACTIVE IMMUNIZATIONPASSIVE IMMUNIZATIONPASSIVE IMMUNIZATION
ACTIVE IMMUNIZATIONACTIVE IMMUNIZATIONPASSIVE IMMUNIZATIONPASSIVE IMMUNIZATION
Control Measures for Control Measures for Nosocomial InfectionNosocomial Infection
InfectionInfectionControl Control MeasuresMeasures
InfectionInfectionControl Control MeasuresMeasures
CHEMO-CHEMO-PROPHYPROPHYLAXISLAXIS
CHEMO-CHEMO-PROPHYPROPHYLAXISLAXIS
IMMUNO-IMMUNO-PROPHYPROPHYLAXISLAXIS
IMMUNO-IMMUNO-PROPHYPROPHYLAXISLAXIS
THERAPYTHERAPYTHERAPYTHERAPYEmployeeEmployee
HealthHealthProgramProgram
EmployeeEmployeeHealthHealth
ProgramProgram
ANTIBIOTICANTIBIOTICIMMUNOTHERAPYIMMUNOTHERAPYSUPPORTIVESUPPORTIVE
ANTIBIOTICANTIBIOTICIMMUNOTHERAPYIMMUNOTHERAPYSUPPORTIVESUPPORTIVE
Control Measures for Control Measures for Nosocomial InfectionNosocomial Infection
InfectionInfectionControl Control MeasuresMeasures
InfectionInfectionControl Control MeasuresMeasures
CHEMO-CHEMO-PROPHYPROPHYLAXISLAXIS
CHEMO-CHEMO-PROPHYPROPHYLAXISLAXIS
IMMUNO-IMMUNO-PROPHYPROPHYLAXISLAXIS
IMMUNO-IMMUNO-PROPHYPROPHYLAXISLAXIS
THERAPYTHERAPYTHERAPYTHERAPYEmployeeEmployee
HealthHealthProgramProgram
EmployeeEmployeeHealthHealth
ProgramProgram
Hepatitis BHepatitis BscreeningscreeningTB ScreeningTB ScreeningImmunizationImmunization
Hepatitis BHepatitis BscreeningscreeningTB ScreeningTB ScreeningImmunizationImmunization
Principles in Infection ControlPrinciples in Infection Control The Health Care Worker (HCW) should The Health Care Worker (HCW) should
be aware of how infection is transmitted be aware of how infection is transmitted and the factors involved in the process.and the factors involved in the process.
The HCW should have the proper The HCW should have the proper attitude of infection control.attitude of infection control.
The HCW should be able to implement The HCW should be able to implement the MOST effective and applicable the MOST effective and applicable measures to prevent and control measures to prevent and control infection in his place of work.infection in his place of work.
Common Sense
inINFECTIONCONTROL
Infection Control is ..... a WAY of
LIFE