Hospital Acquired Infections PDF

Healthcare-Associated Infections (Hospital Acquired Infections) By Prof. Dr. Zainalabideen A. Al- Abdulla, MRCPI, DTM&H., Ph.D., FRCPath. (U.K.) Learning Objectives 1. Describe Healthcare Associated Infections 2. Study the frequency and transmission m...

Healthcare-Associated Infections (Hospital Acquired Infections) By Prof. Dr. Zainalabideen A. Al- Abdulla, MRCPI, DTM&H., Ph.D., FRCPath. (U.K.) Learning Objectives 1. Describe Healthcare Associated Infections 2. Study the frequency and transmission mode of HAI, and common microbes encountered 3. Discuss the different measures of infection control and prevention 4. Describe Personal Protective Equipment (PPE) measures. 5. Know the vaccines recommended for health- care provider. 6. Show different hospital signs of infection control. Healthcare-Associated Infections Infectious diseases are divided into: 1. Healthcare-Associated Infections (HAIs) All infections acquired in hospitals after 48 hr of hospitalization + 14 days after discharge from the hospitals; except: 2. Community-Acquired Infections Present + During incubation when hospitalized “Iatrogenic Infections” caused by medical or surgical intervention, e.g. catheter infection, surgical site infections are a type of HAI Modes of Transmission 1. Contact (direct & indirect) 2. Droplet 3. Airborne Patients most likely to develop HAI Specially immunosuppressed Long hospitalization Frequency of HAIs 5% of hospitalized patients Most predominant HAI: Pneumonia Bacteria in hospitals are drug-resistant; (70% of HAIs) often multidrug-resistant, e.g. Pseudomonas, MDR-TB, HIV, Candida. Table: Shows steps to prevent resistance Most Common Types of HAIs 1. Urinary Tract Infections (UTIs) 2. Surgical site infections 3. LRTI (Pneumonia) 4. Bloodstream infections (septicemia) 5. Clostridium difficle -associated disease: Anaerobic, spore-forming, g+ bacillus Part of indigenous colon microbiota Produce Enterotoxin AAD* Cytotoxin PMC* * (AAD: Antibiotic Associated Diarrhea; PMC: Pseudomembranous colitis) Common Organisms Encountered in Hospitals Recently emerged: Carbapenem-resistant Enterobacteriaceae (CRE) First aim of infection control in hospitals Prevent nosocomial infections: HOW? - Education, e.g. Hands washing - Investigations for multi-drug resistant (MDR and Extended-MDR) organisms - Implementation of policies of cleaning, disinfection, sterilization, & waste disposal - Health workers protection, e.g. exposure to infectious cases, materials, etc. - Prudent use of antibiotics (strict policies) # Rotational use of antimicrobials cont./  Precaution and Isolation The aim here is to prevent transmission of infection to health workers and to other patients - Hand Hygiene (washing/gloves) is the standard measure, e.g. Rota virus, MRSA # Hand washing: Before & after contact (even with the use of gloves; bcz cracks?) # Use soap/water or Manugel (alcohol- based gel; preferable as for Cl. difficle). - Use sometimes gowns, glasses, and mask, e.g. Respiratory cases/secretion as sputum Hand washing (Semmelweis, 1865) Recommendation: - Before/after touching patients - Before/after touching patients’ surroundings - Before/after entering patients’ room/ward - After cleaning, aseptic technique, or body fluid exposure. Hand washing for 30-45 seconds Nail cut (microbes grow under nails heavily) Finger rings (?; may carry same risk as nails)  Safe Waste Disposal - Example 1: Disposable needles - Example 2: Respiratory cases: Mask, disposal of secretion, education (when cough, or sneeze; avoid hand shaking; wash hands) Isolation precaution - Isolate in a single room; if the same organism use cohort isolation (> 1 patient in a room), e.g. Rota virus, Extended MDR bacteria - Medical equipment/tools: Policies & usage of disposable types  Droplet precaution - Droplets > 5 µm; within 1 min. could reach 1 meter from patient (not more); so no need to shut doors of patients’ room. - Wearing masks is recommended for:. Neisseria meningitides. Bordetella pertussis. Haemophilus influenzae. Mycoplasma pneumoniae. Influenza virus. Adenovirus,. SARS-CoV-2  Negative pressure rooms (NPR) - For patients with droplets < 5 µm (stay in the air for a long time) such as seen in TB, SARS (Corona virus), measles, varicella (chicken pox virus), i.e., contagious diseases - NPR: Air enters from outside, vacuumed to be sterilized with HEPA Filter before expelling it out, not allowed to go back. These rooms has double doors, and a special location.  Protective Environment Protective Isolation/Positive Pressure Isolation (prevent air from entering from corridor), sealed-single room, pressure inside is greater than environment, air enters through HEPA filters, e.g. BM transplantation (immuno- suppressed) or IVF technology. HEPA: High Efficiency Particulate Air (Arresting) Filter Left: Inside view of a negative pressure isolation chamber for patients with contagious diseases. Right: Positive Pressure Isolation Chamber for immunocompromised patients or IVF  Protection Precaution - For immunocompromised patients, e.g. receiving chemotherapy: Positive pressure isolation, see above Hand hygiene Prohibit entry of infected persons, e.g. common cold, runny nose, gastroenteritis No flowers or plants (may contain fungi as Aspergillus, bacteria or viruses No fruit or vegetables (unless washed very carefully) Imagine This Culture/ Wash Your Hands  Miscellaneous Points - Hidden/unrecognized infections, e.g. MRSA prevalence in community is 20% - Most meningitis cases become non- infectious after 24 hours of treatment - Cleaning of stethoscope after each exam. is a positive practice. - Washing white coats regularly is highly recommended - Vaccination of health-care workers is an important practice, See next Table Spaulding system for classification of instruments and items for patient care Critical items: Sterile from any microbe e.g. surgical instruments (steam) Semicritical items: High-level disinfection to mm and non-intact skin e.g. Endoscopes (glutaraldehyde) Non-critical items (patient care items and environmental surfaces): Low level disinfection to intact skin (70%-90% ethyl alcohol, bleach) Surgical asepsis Hair clipped/shaved Skin cleaned, scrubbed (soap/antiseptic) Skin covered (sterile plastic film or cloths) Hand washing as described Sterile: gloves, caps, masks, shoe covers Sterile: Instrument, sutures, dressing Disposable needles, syringes, sharps Floors, walls, equipment: Clean/disinfected Standard precautions To ALL patients and ALL healthcare setting Prevention of transmission of infection Semmelweis/1865 “Father of Hand washing” “Father of Hospital Epidemiology” All blood, body fluid, secretions (not sweat), non-intact skin, mm: Contain infectious agents Measures: See Figure Role of Clinical Microbiology Laboratory (CML) Monitor pathogens isolated/computerized Antibiotic susceptibility report Notify about infectious diseases Environmental sampling/source of infection: 1. Biotype*: If similar biochemical results? 2. Antibiogram*: If similar pattern? 3. Molecular epidemiology (plasmid genotyping, chromosomal DNA) * Phenotyping; but Genotyping is better Vaccines for healthcare personnel Personal Protective Equipment (PPE) Gloves (wash hands after use) Isolation gown Mask Eye protection; goggles/face shield Respiratory protection; Type N95 respirator: Used with TB, Severe Acute Respiratory Syndrome (SARS, COVID-19), Smallpox, and influenza Patient-Care Equipment are controlled by PPE. Environmental control; Clean with standard measures Linens; Laundered Disposal of sharps (e.g. HIV, HBV, HCV); Containers  VIDEOS https://www.youtube.com/watch?v=_o9SxDFPUiA https://www.youtube.com/watch?v=zLQ3cvD9xZU