HEALTH CARE ASSOCIATED INFECTIONS AND ITS CONTROL

1. HEALTH CARE ASSOCIATED INFECTIONS AND ITS CONTROL Prof Victor Lim International Medical University

2. HEALTH CARE ASSOCIATED INFECTION • Definition • Any infection acquired by patients or members of staff while in a heath care setting • Does not include infections which manifest in a health care setting but acquired outside the health care setting • Includes infections acquired in a health care setting but manifest after discharge

3. NOSOCOMIAL OR HOSPITAL ACQUIRED INFECTION • Old term • Nosocomium = Hospital • Increasing day-care and ambulatory care in modern medical practice • Chronic care facilities, nursing homes • Confining definitions to hospitals only may not reflect the true situation • Infection control is also important in non-hospital settings – hence health-care associated infections

4. History of Nosocomial Infection • Ignaz Semmelweis, (1840s) demonstrated importance of hand hygiene • No progress for next century • 1976, the Joint Commission on Accreditation of Healthcare Organizations - standards for infection control • Nosocomial infection still on the increase - emerging infection

5. Reasons for Re-emergence • Antibiotic resistance : HCAI becoming more difficult to treat • Increased numbers of vulnerable patients • progress in medical management • increasing day-care & ambulatory care • Failure of staff to comply with infection control procedures

6. CAUSES OF HCAI • Virtually all microorganisms can cause nosocomial infections • Viruses • Bacteria • Fungi • Parasites

7. BACTERIA • Bacteria • Gram + • Staphylococcus aureus • Staphylococcus epidermidis • Gram - • Enterobacteriaceae • Pseudomonas aeruginosa • Acinetobacter baumanni • Mycobacterium tuberculosis

8. NOSOCOMIAL PATHOGENS • Viruses • Blood borne infections : HBV, HCV, HIV • Others: CMV, rubella, varicella, SARS • Fungi • Candida • Aspergillus

9. SOURCES OF INFECTION • Endogenous • source is the normal flora or colonisers of skin and other epithelial surfaces • Exogenous • other persons (cross-infection) • inanimate objects (fomites)

10. SPREAD OF INFECTONS • Air-borne • Skin scales, droplet nuclei • Contact • Direct • Hands & clothing • Droplet contact followed by autoinoculation • Clinical equipment • Indirect • Bedpans, bowls, jugs, etc

11. SPREAD OF INFECTONS The hands are the most important vehicle of transmission of HCAI

12. National NI prevalence rates : Ministry of Health and Teaching Hospitals

13. TYPES OF INFECTIONS • Common infections • Urinary tract infections • Surgical wound infections • Lower respiratory infections • Traumatic wounds and burns infections • Primary bacteraemia

14. Types of infections : National Surveillance Percentage

15. COST OF INFECTIONS United Kingdom 115 million pounds (1988) United States of America 5 billion dollars (1987) 4.5 billion dollars (1995) Malaysia ???

16. CONTROL OF HCAI Hand hygiene is the single most important measure for control of nosocomial infections

17. TYPES OF HAND HYGIENE PROCEDURES • Hand washing • Hand washing is usually limited to hands and wrists • Hands are washed for a minimum of 10 – 15 seconds with soap (plain or antimicrobial) and water • Transient micro-organisms are mechanically removed by rinsing. • Hand antisepsis/decontamination • Hand antisepsis removes or destroys transient micro-organisms and confers a prolonged effect. • Two ways: • Wash hands and forearms with antimicrobial soap and water, for 15-30 seconds • Decontaminate hands with a waterless, alcohol-based hand gel or hand rub for 15-30 seconds. Appropriate for hands that are not soiled with protein matter or fat.

18. TYPES OF HAND HYGIENE PROCEDURES • Surgical hand antisepsis • Removes or destroys transient micro-organisms and confers a prolonged effect. • Hands and forearms are washed thoroughly with an antiseptic soap for a minimum of 2-3 minutes. • Hands are dried using a sterile towel. • Required before performing invasive procedures.

19. HAND WASHING TECHNIQUE Source: World Health Organization. Regional Office for Western Pacific.

20. COMPOUNDS FOR HAND ANTI-SEPSIS • Recommended by WHO • 2%-4% chlorhexidine, • 5%-7.5% povidone iodine, • 1% triclosan, or • 70% alcoholic hand rubs.

21. WHO FIRST GLOBAL PATIENT SAFETY CHALLENGE • Clean care is safer care • Alcohol-based hand rubs must be available at the point of care • As effective as washing with soap or antiseptic and water • More convenient and less time consuming

22. THE SWISS EXPERIENCE • A hand hygiene campaign was launched in January 2006, in 116 hospitals nationwide. • Alcohol-based hand rubs were available at the patient bedside or carried by staff in their pocket. • Overall hand hygiene compliance increased from 54% to 68% - a 25% boost in patient safety. • Nurses’ compliance is 72%. Doctors’ compliance showed an increase of 33% to an encouraging 60% • Prevented 17,000 infections and saved CHF 60 million nationwide. • Hand rubbing now accounts for up to 97% of all hand hygiene actions in Swiss hospitals Source : WHO

23. OTHER MEASURES • Practise aseptic techniques when performing procedures • Limit the duration of in-situ catheters (urinary and intravascular) to shortest possible • Meticulous care of lines, ventilator tubing, catheters and wounds

24. OTHER MEASURES • Isolation of infectious patients and immuno-compromised patients • Source isolation • Protective isolation • Use of single rooms with bathroom attached • Use of positive or negative pressure rooms • Protect yourself appropriately through good practices and using personal protective equipment (STANDARD PRECAUTIONS)

25. PRACTISE STANDARD PRECAUTIONS

26. PROTECT YOURSELF THROUGH IMMUNISATION Immunisation BCG Hepatitis B Tetanus Rubella Varicella Influenza

27. CONCLUSIONS • Preventing HCAI is a very important aspect of patient safety • All health care personnel must practise the highest standards of infection control as HCAIs • Cause significant morbidity and mortality to patients and health care staff • Contribute to increasing prevalence of antibiotic resistance • Are difficult and expensive to manage • Can result in medical litigation