Practical methods to control hospital acquired infections presented by : Faiqa ali chughtai
Practical methods to control hospital acquired
infections
presented by : Faiqa ali chughtai
Case 1:
• 1 yr old male child• Presented with fever, respiratory distress and
stidor• Intubation was performed and
dexamethasone was administered• After two days , child presented with signs and
symptoms of aspiration pneumonia
Case 2:
• A 5 months old male child • presented with a.w.d , severe dehydration &
acute kidney dysfunction• Rehydration • For Kidney function monitoring urinary
catheter was inserted• With in 36 hrs diarrhea was resolved, but
patient showed signs of infection
Case 3 :• 5 years old female presented to hospital with fever ,
respiratory distress• 1st diagnosed as T.B pt , latter ruled out, ceftriaxone was
prescribed and held latter diagnosed with pneumonia• Benzyl penicillin & co amoxicalve were prescribed• No improvement was found after 3 days ciprofloxacin
was prescribed but in sub therapeutic dose, • Latter effusion n consolidation was diagnosed • and vancomycin ,tanzo and clarithromycin were added
to regimen• after 20 days the microbe was found resistant to
quinolones, aminoglycocides, microlides , beta lactam antibiotics. Only vancomycin was effective
Point to ponder !
• Similarity between these cases:• All were by inflicted by
infections after admission to hospital
Conditions in our hospital
NOSOCOMIAL INFECTIONS
• Hospital acquired infections / nosocomial infections.
• The term "nosocomial" comes from two Greek words:
• "nosus" meaning "disease" + "komeion" meaning "to take care of.“
• Hence, "nosocomial" should apply to any disease contracted by a patient while under medical care .
Definition
According to WHO• An infection acquired in hospital by a patient who
was admitted for a reason other than that infection .
• An infection occurring in a patient in a hospital or other health care facility in whom the infection was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility .
Commonly occurring nosocomial infection
Who is responsible for noscocomial infections?
1 •Patient –for visiting hospital•for weak immunity
2 •Doctor-for prescribing antibiotics•For invasive procedures
3 •nurses-for not using aseptic procedures
4 •Hospital cleaners-for not being glued to mop & phenyl
5 •Microbes-for being there in 1st place
Where is pharmacist in this chain?May be we are too busy in avoiding the blame
Factors effecting nosocomial infections
Patient susceptibility • Endogenous
infections• immunity• Normal flora• Malnutrition
Iatrogenic • Treatment &
intervention related
• Anti microbial resistance
• Involvement of pharmacist
Microbial agents & organizational • Cross
contaminations• Facilities• hygiene• Microbial flora
of unit • Vectors of
microbes• overcrowding
Known nosocomial infections
• Ventilator-associated pneumonia• Staphylococcus aureus• Methicillin resistant Staphylococcus aureus• Candida albicans• Pseudomonas aeruginosa• Acinetobacter baumannii• Stenotrophomonas maltophilia• Clostridium difficile• Tuberculosis• Urinary tract infection• Hospital-acquired pneumonia• Gastroenteritis• Vancomycin-resistant Enterococcus• Legionnaires' disease
Strategy for control1 •Take care of already present
infections
2 •Control iatrogenic factors & AMR
3 •Establish infection control committee
4 •Define roles
5 •Role of pharmacist
6 •Surveillance & policies
7 •Training & education
8 •Cleanliness & hygiene
9 •Control airborne , waterborne , infections
10 •Control vector of infection
Infection control committee
• Involving management, physicians, other health care workers, clinical microbiology, pharmacy, central supply, maintenance, housekeeping, training services
• must report directly to either administration or the medical staff to promote program visibility and effectiveness.
Review & approve surveillance policy
Identify areas of intervention
Promote healthy pactice
ensure appropriate staff training
review risks associated with new devices & treatment
Provide input into investigation
of epidemics
Promote co-operation between health care providers and committees working in hospital
Management • education and
training • reviewing the
nosocomial infections
• Ensure authority of infection control team
Physician & nurses• Comply with
infection control policies
• Use aseptic techniques
• Take proper med for infections they have
Pharmacist • Promoting
pharmaceutical preparations that prevent
• transmission of infectious agents
• Maintain relevant record of antimicrobials
• Maintain appropriate storage
ROLE OF PHYSICIAN, MICROBIOLOGIST & PHARMACIST IN Control of AMR
• Combine microbial sampling+biomarkers+diagnosis+treatment
• Go for early diagnosis, early therapy within 48-72 hrs
• Avoid longer stay at hospital• Go for de-escalation policy• Selective on basis of microbe• Decrease dose in acc. With infection condition• monotherapy
Control of nosocomial infections• 1st: treat present infections:• Treatment for resistant microbes
Hospital acquired infection
•Ceftriaxone•Imipenum
Ampicillin resistant
•Ampi+salbactum
MRSA •vancomycin
VRE enterococci
•Linezolid,tigecycline
Do surveillance Make list of a.bPrescribe
acc.to narrow spectrum
Use prophylactic a.b if proved
valuable
•Perform antibiotic susceptibility test and monitor the trends in prevalence of bacterial resistance to antimicrobial agent. •Make list ,prescribe according to that.•Tailor list according to institutional microbial flora
Pharmaceutical preparations
• obtain• Store • distribute
Maintain record
•Potency•Incompatibility•Storage conditions•Deterioration conditions
Summary reports
•Provide reports to •Antimicrobial use committee•Infection control committee
Role of pharmacist
Info
on
antimicrobials
Properties:Concentration, TemperatureLength of actionSpectrumToxic propertiesIncompatibilitiesHarmful effects
Disinfection
Develop guidelines and productsMonitor Q.C of sterilization procedures
Therapy dev
elop
ment
Develop institution tailored therapy
Role of pharmacist
ROLE OF NURSES & PHYSICIANS
– Use of aseptic techniques while administering parental
– Use of gloves, and hand washing practice– Use of no touch technique , as far as possible.– Keeping check of i/v & catheter inflicted infections– Ensure that housekeeping is performing its
functions properly
DEVELOPMENT OF PERFORMANCE MANUALS
• Infection control committee must develop manuals for , food providing services , housekeeping services , laundry services, hospital hygiene services
• Organize surveillance program for nosocomial infections
• Involve pharmacy in development of supervision program for use of anti infective drugs
Education & training
• Organize teaching programs for medical , nursing , allied health personnel
• Arrange courses for awareness of pharmacist so that they may supervise nursing staff for
proper dispensing of medicines • Provide expert advice , analysis & leadership in
outbreak investigation & control• Undertake research in hospital hygiene &
infections
• Rates OF infection are obtained by dividing a numerator (number of infections or infected patients observed) by a denominator (population at risk, or number of patient-days of risk). The frequency of infection can be estimated by prevalence and incidence indicators
PHASES of nosocomial infections control
• Surveillance • Policy development
1st phase
Arrest of Modes of transmission
Contact transmission
• Droplet transmission
Airborne transmission
• Common vehicle transmission
Vector borne transmission
Methods to control modes of transmission
• Reducing person-to-person transmission• Hand decontamination• Safe injection administration• Preventing transmission from the
environment
UTI
SURGICAL SITE INFECTION
PNEUMONIA
VASCULAR DIVICE INFECTION
MEASURES FOR CONTROL OF
NOSOCOMIAL INFECTIONS
Guidelines for physicians, nurse & pharmacist
• Wash hands promptly after contact with infective material
• Use no touch technique wherever possible• Wear gloves when in contact with blood, body
fluids, secretions, excretions, mucous membranes
and contaminated items• Wash hands immediately after removing gloves• All sharps should be handled with extreme care
Guidelines • Clean up spills of infective material promptly• Ensure that patient-care equipment, supplies
and linen contaminated with infective material is either discarded, or disinfected or sterilized between each patient use
• Ensure appropriate waste handling• If no washing machine is available for linen
soiled with infective material, the linen can be boiled.
Cleaning of the hospital environment
• Zone a-no pt –normal domestic cleaning• Zone b-pt –non infected-not highly susceptible-
no dry cleaning, use of detergent solutions• Zone c-infected pts-disinfectant/detergent
solution, separate cleaning equipment for each unit
• Zone d-highly susceptible pts-protected/ isolated-disinfectant/detergent solution, separate cleaning equipment for each unit
Sterilization & disinfection
• Use of hot/superheated water• Disinfection with hot water• 1. Sanitary 80 °C 45–60 seconds equipment• 2. Cooking 80 °C 1 minute utensils• 3. Linen 70 °C 25 minutes 95 °C 10 minutes
Waterborne infections
• Gram-negative bacteria:• Pseudomonas aeruginosa• Aeromonas hydrophilia• Burkholderia cepacia• Stenotrophomonas maltophilia• Serratia marcescens• Flavobacterium meningosepticum
Water born infections
• Acinetobacter calcoaceticus• Legionella pneumophila and other• Mycobacteria:• Mycobacterium xenopi• Mycobacterium chelonae• Mycobacterium avium-intracellularae
Microbiological monitoring• Regulations for water analysis (at the national level
for drinking-water, in the Pharmacopoeia for pharmaceutical waters) define criteria, levels of impurities, and techniques for monitoring.
• Methods used for monitoring must suit the use.• Infections attributable to water are usually due to
failure to meet water quality standards for the specific use.
• Infection control/hygiene teams must have written, valid policies for water quality to minimize risk of adverse outcomes attributable to water in health care
settings.
Airborne infections
• Depend on :• 1.Type of infections• 2. Quality of air provided• 3. Rate of air exchange• 4. Number of persons present in wards• 5. Movement of personnel• 6. Level of compliance with infection control practices• 7. Quality of staff clothing• 8. Quality of cleaning process
Control of airborne infections
• Appropriate ventilation is necessary, and must be monitored within risk areas, e.g. orthopedics, vascular surgery and neurosurgery.
• Unidirectional airflow systems should be incorporated in appropriate areas in new hospital construction
Control of vectors
• Arthropods :• Cockroaches are source of Streptococcus species• Bacillus species (except Bacillus subtilis) • Bacillus subtilis• Staphylococcus aureus• Staphylococcus epidermidis• Enterococcus species• Corynebacterium species
control of cockroaches
• The keys to controlling cockroaches are sanitation and exclusion: cockroaches are likely to reinvade as long as a habitat is suitable to them (i.e., food, water, and shelter are available)
• Sprays can be used to suppress the population
sterilization
Precautionary measures to avoid infections
• traffic flow to minimize exposure of high-risk patients and facilitate patient transport
• adequate spatial separation of patients• adequate number and type of isolation rooms• appropriate access to hand washing facilities• appropriate ventilation for isolation rooms
and special patient care areas (operating theatres,transplant units)
• preventing patient exposure to fungal spores with renovations
Final solutionCO-ORDINATION & CO-OPERATION
physician
microbiologist
Cleaning & housekeeping
dptnurses
pharmacist