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Healthcare-Associated I nfections O ccurring in Hospitals

Healthcare-Associated I nfections O ccurring in Hospitals. Darline Dupree PhD Student Walden University PUBH 8165-2 Instructor: Dr. Robert Marino Winter 2012. Stakeholders. Hospital Board of Directors OSHA County Public Health Departments Center for Disease Control (CDC)

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Healthcare-Associated I nfections O ccurring in Hospitals

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  1. Healthcare-Associated Infections Occurring in Hospitals Darline Dupree PhD Student Walden University PUBH 8165-2 Instructor: Dr. Robert Marino Winter 2012

  2. Stakeholders • Hospital Board of Directors • OSHA • County Public Health Departments • Center for Disease Control (CDC) • Environmental Health Department • Healthcare Practitioners

  3. Objectives • Generate awareness concerning Hospital-Associated Infections (HAIs) • Generate awareness regarding the varying types of HAIs • Generate awareness regarding the financial burden that HAI’s pose on hospitals • Promote practitioners adherence to infection prevention guidelines • Promote the enhancement of Infection Surveillance Systems • Improve hospital infectious control policies • Promote quality of care practices that minimize HAI risk

  4. At The End Of This Presentation You Will Be Able To: • Define Hospital Associated Infections • Explain HAI impact on public health • Identify four of the most common infections occurring in hospitals • Name preventative measures used to prevent/control HAIs • Explain the impact of HAI on low-income developing countries • Explain HAI surveillance systems • Identify states with laws requiring HAI reporting • Understand the importance of activating infection control requirements

  5. What are Hospital-Associated Infections (HAIs)? • “Hospital-Associated Infections (HAI) are infections caused by a wide variety of common and unusual bacteria, fungi, and viruses during the course of receiving medical care” (CDC, 2011) • Infections that develop during hospitalization that are not present nor incubating upon the patient’s admission to the hospital (Collins, 2008) Center for Disease Control and Prevention. Healthcare associated infections. Retrieved on January 19, 2012 from: http://www.cdc.gov/hai/ Collins A., S. (2008) Preventing Healthcare –Associated infections, Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2683/

  6. Healthcare Settings Vulnerable to Infections • Traditional hospital • Outpatient surgery centers • Long-term care facilities • Rehabilitation centers • Community clinics

  7. Public Health Burden of HAI • Health • 1 out of every 20 patients contract some form of hospital related infections • HAI is responsible for approximately 90, 000 deaths annually • Financial • Responsible for approximately $28.4 billion to $33.8 billion dollars in direct healthcare cost • Responsible for approximately $8.5 billion in overall hospital net cost Center for Disease Control and Prevention. Healthcare associated infections: Burden. Retrieved on January 19, 2012 from: http://www.cdc.gov/HAI/burden.html Scott, D. R. (2009). The Direct Medical costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. Retrieved on January 30, 2012 from: http://www.cdc.gov/HAI/pdfs/hai/Scott_CostPaper.pdf

  8. Types of HAIs • Device related infections • Central Line-Associated Bloodstream Infection (CLABSI) • Catheter-Associated Urinary Tract Infection (CAUTI) • Ventilator-Associated Pneumonia (VAP) • Procedure related infections • Surgical Site Infection (SSI) Center for Disease Control and Prevention. Healthcare associated infections: Infection Types. Retrieved on January 1, 2012 from http://www.cdc.gov/HAI/infectionTypes.html

  9. Most common type of infections occurring in hospitals within the US annually • UTI accounts for 36% • SSI accounts for 20% • Bloodstream infection (BSI) accounts for 11% • Pneumonia accounts for 11% World Health Organization (2011). Report on the Burden of Endemic Health Care-Associated Infection Worldwide: Clean Care is Safer Care (ISBN 978 92 4 150150 7))

  10. Catheter Associated Urinary Tract Infection (CAUTI) • Most common type of hospital-associated infections • Responsible for between approximately 75%-97% of urinary tract infections in the hospital • Accounts for approximately > 30% of HAIs infections • Responsible for an Estimated 13,000 HAI deaths annually • Occurs when bacteria enters the urinary tract through the urinary catheter • Prolonged use of urinary catheter increase the risk for infections World Health Organization (2011). Report on the Burden of Endemic Health Care-Associated Infection Worldwide: Clean Care is Safer Care (ISBN 978 92 4 150150 7). Center for Disease Control and Prevention. Healthcare associated infections: Retrieved January 15, 2012 from: http://www.cdc.gov/HAI/pdfs/toolkits/CAUTItoolkit_3_10.pdf

  11. Preventing CAUTIs • Perform proper hand hygiene practices in accordance to CDC recommended standard precautions • Insert catheters only when needed • Remove catheters immediately when the need for it no longer exist • Use aseptic techniques for insertions • Maintain a closed drainage system Center for Disease Control and Prevention. Top CDC Recommendations to Prevent Healthcare Associated Infections. Retrieved on January 30, 2012 from: http://www.cdc.gov/HAI/prevent/top-cdc-recs-prevent-hai.html

  12. Surgical Site Infection (SSI) • Infection occurring after surgery in the part of the body that was operated on • Accounts for approximately 300,000 of all HAI cases • Responsible for 75% of SSI associated deaths • Infections range from superficial to serious • Approximately 12% to 84 % of surgical site infections are discovered after patients are released from the hospital • most infections discovered within 21 days after surgical operation Center for Disease Control and Prevention. Healthcare associated infections: FAQs about SSI. Retrieved January 15, 2012 from: http://www.cdc.gov/HAI/ssi/faq_ssi.html Collins A., S. (2008) Preventing Healthcare –Associated infections, Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2683/

  13. Preventing SSI • Administer antimicrobial prophylaxis • Prepare surgical site of skin with an antiseptic agent • Treat remote infections prior to performing operations • Use sterilized instruments to perform surgery • Maintain a sterile environment by limiting traffic in the operating room • Use sterile dressings to protect incisions Center for Disease Control and Prevention. Top CDC Recommendations to Prevent Healthcare Associated Infections. Retrieved on January 30, 2012 from: http://www.cdc.gov/HAI/prevent/top-cdc-recs-prevent-hai.html

  14. Central Line-Associated Bloodstream Infection (CLABSI) • Occurs when bacteria or viruses enters the bloodstream through the catheter • Marked by fever and soreness around the area where the catheter was inserted • Responsible for up to 35% of HAI related mortalities • Responsible for approximately 87% of BSI World Health Organization (2011). Report on the Burden of Endemic Health Care-Associated Infection Worldwide: Clean Care is Safer Care (ISBN 978 92 4 150150 7). Center for Disease Control and Prevention. Healthcare associated infections: Retrieved January 15, 2012retrieved from :http://www.cdc.gov/HAI/pdfs/toolkits/CLABSItoolkit_white020910_final.pdf

  15. Preventing Central Line-Associated Bloodstream Infection • Perform proper hand hygiene practices in accordance to CDC recommended standard precautions • Select an insertion site least vulnerable to infections • Wear sterile surgical protective gear • Properly insert central lines • Use appropriate agent for skin antisepsis • Remove central line when no longer needed Center for Disease Control and Prevention. Top CDC Recommendations to Prevent Healthcare Associated Infections. Retrieved on January 30, 2012 from: http://www.cdc.gov/HAI/prevent/top-cdc-recs-prevent-hai.html

  16. Ventilator-Associated Pneumonia (VAP) • Lung infection that develop in a person who is on a ventilator • Infection occurs when germs enter the tube and accumulate in the patient’s lungs • Accounts for 83% of hospital associated pneumonia World Health Organization (2011). Report on the Burden of Endemic Health Care-Associated Infection Worldwide: Clean Care is Safer Care (ISBN 978 92 4 150150 7)

  17. Preventing VAP • Perform proper hand hygiene practices in accordance to CDC recommended standard precautions • Elevate the bed of patients( varies based upon age in pediatrics) • Remove the ventilator as soon as the patient is able to breathe without it. Center for Disease Control and Prevention. Top CDC Recommendations to Prevent Healthcare Associated Infections. Retrieved on January 30, 2012 from: http://www.cdc.gov/HAI/prevent/top-cdc-recs-prevent-hai.html

  18. Emerging Infections Commonly Associated With HAI • Antibiotic associated • Clostridium difficile infection (CDAD) • Antibiotic resistant infections • Methicillin-resistant Staphylococcus aureus (MRSA) Infection

  19. Clostridium difficileInfection (C.diff) • Spore-forming, gram-positive anaerobic bacillus bacterium • Accounts for 15%-25% of all episodes of antibiotic-associated diarrhea • Responsible for 9,000 deaths annually • Occurs most often in elderly people and people with certain medical problems • Causes diarrhea and other serious intestinal conditions • Transmission • Contaminated bed linens, bed rails, bathroom fixtures and medical equipment • Person to person on the hands of hospital personnel and visitors Center for Disease Control and Prevention. Healthcare associated infections. Retrieved on January 14, 2012 from: http://www.cdc.gov/HAI/organisms/cdiff/Cdiff_faqs_HCP.html Center for Disease Control and Prevention. Healthcare associated infections: Retrieved January 15, 2012 from: http://www.cdc.gov/HAI/pdfs/toolkits/CDItoolkitwhite_clearance_edits.pdf

  20. Preventing Clostridium difficile Infections (CDI) • Perform proper hand hygiene practices in accordance to CDC recommended standard precautions • Clean and disinfect equipment and overall environment • Utilize contact precautions during the duration of diarrhea • Isolate symptomatic patients • Implement universal glove use Center for Disease Control and Prevention. Top CDC Recommendations to Prevent Healthcare Associated Infections. Retrieved on January 30, 2012 from: http://www.cdc.gov/HAI/prevent/top-cdc-recs-prevent-hai.html

  21. Methicillin-Resistant Staphylococcus Aureus(MRSA) Infection • Staph bacteria resistant to certain antibiotics • Occurs more often among patients who undergo invasive medical procedures or who have weakened immune systems • Causes severe and potentially life-threatening infections • 25% of MRSA cases occur in the hospital • Transmission • Spread from patient to patient on unclean hands of healthcare personnel or through the improper use or reuse of equipment • Hands may become contaminated with MRSA by contact with: colonized or infected patients; devices, surfaces contaminated with body fluids, infected hospital personnel Center for Disease Control and Prevention. Hospital associated infections: Methicillin-resistant Staphylococcus aureus (MRSA) Infection. Retrieved on January 14, 2012 from: http://www.cdc.gov/HAI/organisms/mrsa-infection.html Center for Disease Control and Prevention. Symptoms of MRSA. Retrieved on January 14,2012 from: http://www.cdc.gov/mrsa/symptoms/index.html Center for Disease Control and Prevention. Protect Yourself from MRSA . Retrieved on January 14, 2012 from: http://www.cdc.gov/Features/MRSAinHealthcare/

  22. Preventing MRSA • Perform proper hand hygiene practices in accordance to CDC recommended standard precautions • Implement contact precautions for colonized and infected MRSA patients • Immediately report MRSA lab results Center for Disease Control and Prevention. Top CDC Recommendations to Prevent Healthcare Associated Infections. Retrieved on January 30, 2012 from: http://www.cdc.gov/HAI/prevent/top-cdc-recs-prevent-hai.html

  23. Contributing Factors of HAI • Endogenous • Body sites that house microorganisms as part of the normal microbial flora • Ex. skin, nose, mouth gastrointestinal tract, vagina • Exogenous • Sources external to the patient • Ex. medical devices, health-care workers, healthcare environment, visitors, patient care equipment WHO (2011) Report on the burden of Endemic Health Care- Associated Infection Worldwide. Retrieved on January, 14, 2012 from http://whqlibdoc.who.int/publications/2011/9789241501507_eng.pdf

  24. Patient Susceptibility • Compromised immune systems • Primary immunodeficiency (e.g., anemia or autoimmune disease) • Secondary immunodeficiency’s (e.g., chemotherapy, corticosteroids, diabetes, leukemia) Collins A., S. (2008) Preventing Healthcare –Associated infections, Retrieved on January 14, 2012 from: http://www.ncbi.nlm.nih.gov/books/NBK2683/

  25. High Risk Patients • Patients admitted to ICUs • Burn patients • Transplant patients • Neonates

  26. Examining the Global Burden of HAI

  27. What is Known • HAI is an issue that extends past our US borders • HAIs are more frequent in resource-limited settings than in developed countries WHO(2011)Health care-associated infections :FACT SHEET. Retrieved on January 12, 2012 from http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf

  28. HAI in Low-income Developing Countries • 15 out of every 100 patients hospitalized in low-income developing countries acquire HAI • SSI is the leading infection within the general patient population • Central vascular lines, ventilators, and urinary catheters are approximately 19 times higher in low- income countries • Newborn HAI rates are 3- 20 times higher in low-income developing countries then in high income countries • Responsible for 4% to 56% of all causes of death with the numbers increasing to 75% in countries such as South-East Asia and Sub-Saharan Africa. • HAI is more frequent in critically-ill patients admitted to ICUs. • Account for 42.7 episodes per 1000 patient-days in developing countries WHO(2011)Health care-associated infections :FACT SHEET. Retrieved on January 14,201 from http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf

  29. Determinants of HAI Specific to Low-income Countries • Insufficient environmental sanitary conditions and waste disposal • Meager infrastructure • Inadequate equipment • Understaffing • Overcrowding • Poor knowledge and application of basic infection control measures • Nonexistent local and national guidelines • Insufficient hospital policies • Unawareness of injection and blood transfusion safety

  30. Pathway to Addressing the Problem

  31. Primary Prevention is Key • “Primary prevention offers the hopes of eliminating unnecessary illness, injury, and even death” (Cohen et al, 2010) • Improves health • Reduces Cost • Requires concerted efforts by all healthcare practitioners, public health officials, governmental officials and the general public Cohen, L., Chavez, V., Chehimi, S. (2010). Prevention is Primary. San Francisco, CA: Josey-Bass

  32. Focus of Prevention at the National and International Level • Implement policies for the development of HAI prevention programs • Action Plan to Prevent Healthcare Associated Infections • 29 states and the District of Columbia passed laws related to HAI prevention • 3 States developed reporting procedures that don’t require legislations • Activate infection control requirements. • Appropriate training, accreditation and licensure to encourage adherence to infection control requirements • Encourage continued research to acclimatize surveillance protocols and preventive strategies. Center for Disease Control and Prevention and Association of State and Territorial Health Officials (2011) Eliminating Healthcare Associated Infections. Retrieved from http://www.cdc.gov/HAI/pdfs/toolkits/toolkit-HAI-POLICY-FINAL_03-2011.pdf

  33. Focus of Prevention at the National and International Level • Establish minimum reporting requirements for all healthcare facilities • Status of current Surveillance System • National Healthcare Safety Network (NHSN) • Secure web-based system that facilitates reporting from healthcare facilities • Mandated by 23 states and the District of Columbia • Intended use in approximately 5,000 hospitals within the U.S. 23 developing countries (23/147) reported a functioning national surveillance system Center for Disease Control and Prevention and Association of State and Territorial Health Officials (2011) Eliminating Healthcare Associated Infections. Retrieved from: http://www.cdc.gov/HAI/pdfs/toolkits/toolkit-HAI-POLICY-FINAL_03-2011.pdf

  34. U.S. States With Laws Requiring the Reporting of Hospital Associated Infections • Alabama • California • Colorado • Connecticut • Delaware • Washington D.C. District of Columbia • Florida • Hawaii • Illinois • Maine • Maryland • Massachusetts • Minnesota • Missouri • New Hampshire • New Jersey • New Mexico • New York • Ohio • Oklahoma • Oregon • Pennsylvania • Rhode Island • South Carolina • Tennessee-limited • Texas • Virginia • Vermont • Washington • West Virginia The committee to reduce infectious disease (2011). Retrieved on January 12, 2012 from : http://www.hospitalinfection.org/legislation.shtml

  35. Focus Prevention at the Hospital Level • Minimize environmental exposure • Implement standard precautions to include best hand hygiene practices • Develop hospital policies and procedures geared toward protecting health and safety • Include appropriate preventive measures for hospital related infection risks • Train staff on the principles of infection control • comply with requirements for staff education and training as established through existing federal, state, and local regulations • Coordinate efforts with the infection control department in monitoring and investigating potentially harmful infectious exposures and outbreaks among personnel

  36. Positive Strides Toward HAI Prevention • American Recovery and Reinvestment Act • Signed into law on February 17, 2009 • Designed to stimulate economic recovery in various ways including strengthening the nation's healthcare infrastructure and reducing healthcare costs • Authorize $50 million to support states in the prevention and reduction of Healthcare Associated Infections Center for Disease Control and Prevention. Healthcare associated infections: Retrieved on January 15, 2012 from: http://www.cdc.gov/HAI/recoveryact/

  37. Positive Strides Toward HAI Prevention • Patient Protection and Affordable Care Act of 2010 • Health Reform • Reimbursement of Medicare/Medicaid funding contingent upon HAI prevention • CMS Hospital Inpatient Quality Reporting Program • de facto national mandate • 95% of hospitals participates in this program • Requires hospitals to report select infections • CLABSI’s in ICUs • Certain SSI Center for Disease Control and Prevention and Association of State and Territorial Health Officials (2011) Eliminating Healthcare Associated Infections. Retrieved from http://www.cdc.gov/HAI/pdfs/toolkits/toolkit-HAI-POLICY-FINAL_03-2011.pdf

  38. Moving Forward • Be proactive • Partner with other agencies to enhance prevention strategies • Familiarize yourself with the statues and regulations surrounding HAI prevention • Foster relationships with and engage stakeholders in HAI programs • Educate the public on HAI

  39. Conclusion • Hospital Associated Infections poses a serious threat to the health and financial viability of the healthcare system in general. • The elimination of HAI is going to take a concerted effort from all healthcare practitioners • In order to improve infectious control policies and enhance infection surveillance systems, there must be collaboration and involvement from policymakers, and governing/regulatory entities • Focus must be placed on better educating service providers on infection control techniques

  40. Questions

  41. References • Center for Disease Control and Prevention. Healthcare associated infections: Burden Retrieved on January 19, 2012 from: http://www.cdc.gov/HAI/burden.html • Center for Disease Control and Prevention. Healthcare associated infections: Infection Types. Retrieved on January 1, 2012 from http://www.cdc.gov/HAI/infectionTypes.html • Center for Disease Control and Prevention and Association of State and Territorial Health Officials (2011) Eliminating Healthcare Associated Infections • World Health Organization (2011). Report on the Burden of Endemic Health Care-Associated Infection Worldwide: Clean Care is Safer Care (ISBN 978 92 4 150150 7). • Center for Disease Control and Prevention. Healthcare associated infections: Retrieved January 15, 2012 from: http://www.cdc.gov/HAI/pdfs/toolkits/CAUTItoolkit_3_10.pdf • Center for Disease Control and Prevention. Healthcare associated infections: FAQs about SSI. Retrieved on January 15, 2012 from: http://www.cdc.gov/HAI/ssi/faq_ssi.html • Collins A., S. (2008) Preventing Healthcare –Associated infections, Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2683/

  42. References • Center for Disease Control and Prevention. Healthcare associated infections. Retrieved on January 14, 2012 from: http://www.cdc.gov/HAI/organisms/cdiff/Cdiff_faqs_HCP.html • Center for Disease Control and Prevention. Healthcare associated infections: Retrieved on January 15, 2012 from: http://www.cdc.gov/HAI/pdfs/toolkits/CDItoolkitwhite_clearance_edits.pdf • WHO(2011)Health care-associated infections :FACT SHEET. Retrieved from http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf • Center for Disease Control and Prevention. Healthcare associated infections: Retrieved on January 15, 2012 from: http://www.cdc.gov/HAI/recoveryact/ • Cohen, L., Chavez, V., Chehimi, S. (2010). Prevention is Primary. San Francisco, CA: Josey-Bass • Scott, D. R. (2009). The Direct Medical costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. Retrieved on January 30, 2012 from: http://www.cdc.gov/HAI/pdfs/hai/Scott_CostPaper.pdf • Center for Disease Control and Prevention and Association of State and Territorial Health Officials (2011) Eliminating Healthcare Associated Infections Retrieved from http://www.cdc.gov/HAI/pdfs/toolkits/toolkit-HAI-POLICY-FINAL_03-2011.pdf

  43. Resources for Further Reading • Infection Control Policies and Hospital-Associated Infections Among Surgical Patients: Variability and Associations in a Multicenter Pediatric Setting. (www.pediatrics.org/cgi/doi/10.1542/peds.2004-2014) • Diseases and Organisms in Healthcare Settings. (www.cdc.gov/HAI/organisms/organisms.html) • National healthcare Safety Network (NHSN) Report, data summary for 2010, device associated module (www.cdc.gov/nhsn/PDFs/dataStat/2009NHSNReport.pdf)

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