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Infection prevention - an appropriate response
- 1. Infection prevention ‘An appropriate response’
- 2. The question… • Which is better – Measures to prevent infection Or – Allowing infection to develop then treating
- 4. What has made the biggest impact on health in the last century? • Vaccination • Safer workplaces • Prevention and control of Infectious diseases • Road safety • CV disease prevention • Nutrition • Maternal and infant health • Family planning • Fluorination of drinking water • Tobacco control CDC. Ten great Public Health Achievements – United States, 1900-1999. JAMA 1999; 281: 1481-3.
- 5. What has made the biggest impact on health in the last century? • Vaccination • Safer workplaces • Prevention and control of Infectious diseases • Road safety • CV disease prevention • Nutrition • Maternal and infant health • Family planning • Fluorination of drinking water • Tobacco control CDC. Ten great Public Health Achievements – United States, 1900-1999. JAMA 1999; 281: 1481-3.
- 6. Infection prevention • Sanitation • Vaccination • Prophylaxis • Processes to prevent HCAI
- 7. Semmelweis Hand-washing reduces puerperal fever (!) Ideas rejected by medical community A man before his time
- 9. Is trying to prevent HCAI worthwhile? • Impact of HCAI • Hand washing • CLABSI • CAUTI • VAP • SSI • Cost-effectiveness
- 10. Impact of HCAI • 10% of hospitalised patients develop infections • In the UK – 100000 HCAIs – 10000 deaths – Cost of 1 billion pounds UK national audit office. The management and control of hospital acquired infection in acute NHS Trusts in England. London: the stationery office, 2000.
- 11. Service delivery • Increased length of stay • Increased re-admissions • USA – hospitals no longer paid for the following conditions – CAUTI – CLABSI – SSI post cardiac surgery
- 12. Hand-washing
- 13. • Hand hygiene data for staff, visitors and patients showed significant correlation with MRSA transmission (p<0.001)
- 14. • Evaluation of the UK ‘clean your hands campaign’ • Three-fold increase in soap/alcohol rub procurement • Falling rate of – MRSA bacteraemia (1.88 to 0.91 cases per 10 000 bed days) – C. Difficile infection (16.75 to 9.49 cases)
- 15. CLABSI • Common, costly and potentially lethal • US – estimated 80,000 infections/year – 28,000 deaths – Average cost $45,000
- 16. • Before, during and 18 months after intervention • Mean rate decreased from 7.7 (per 100 catheter days) to 1.4 (p,0.002)
- 18. CAUTI • 30-40% of all nosocomial infections • 95% associated with indwelling catheter • Around 10% of catheterised patients in ICU will develop UTI • Results in – prolonged ICU stay; 26 vs 13 days (p<0.001) – Prolonged hospital stay; 49 vs 29 days (p,0.001)
- 19. VAP • Incidence of 1-4 per 1000 ventilator days • Cause of significant patient – Mortality (>10%) – Morbidity – Cost
- 20. SSI • SSI in 2-5% of patients undergoing in-patient surgery • Each incident associated with 7-10 additional in-patient days • 2-11 X increased risk of death
- 21. Achievable? • SENIC project, 1985 – 6% of infections could have been prevented with minimal infection control measures – 32% could have been prevented with a well organised programme
- 23. • Evaluated effectiveness of a programme to reduce HCAI over 4 years • 19% reduction in selected HCAIs saving $9m • Total cost of the programme $6.7m
- 24. • Thought to be preventable • 65%–70% of cases of CLABSI and CAUTI • 55% of cases of VAP and SSI
Notas del editor
- A bit of a philosophical questionIs the question whether prevention of hospital infection is effective?Or is it a question over whether the infection prevention measures that we use work?
- What has made the biggest impact on life expectancy in the recent past?
- Focus of this debate is HCAI
- Described as the "savior of mothers",[3] Semmelweis discovered that the incidence of puerperal fever could be drastically cut by the use of hand disinfectionin obstetrical clinics.[3] Puerperal fever was common in mid-19th-century hospitals and often fatal, with mortality at 10%–35%. Semmelweis proposed the practice of washing with chlorinated lime solutions in 1847[Despite various publications of results where hand-washing reduced mortality to below 1%, Semmelweis's observations conflicted with the established scientific and medical opinions of the time and his ideas were rejected by the medical community. Some doctors were offended at the suggestion that they should wash their hands and Semmelweis could offer no acceptable scientific explanation for his findings
- His work was ridiculed and degradedSubsequent work of Louis Pasteur (vaccination) and Lister (antiseptics)
- Disinfection, sterilisationIsolation Stewardship
- hand washing, using full-barrier precautions during the insertion of central venous catheters, cleaning the skin with chlorhexidine, avoiding the femoral site if possible, and removing unnecessary catheters.
- Canadian study with introduction of programme
- Urinary tract infections, methicillin-resistant Staphylococcus aureus, and bacteremias incurred the greatest costs. A reduction of 4,739 HAI cases led to avoided costs of $9.1 million in 4 years; the IPC program budget was $6.7 million during this period. Regionalization of the IPC program with standardized policies, procedures, and initiatives led to a 19% reduction in selected HAIs over 4 years and a cost avoidance of at least $9 million. This was particularly evident in years 3 and 4 of the program when $7.2 million (79% of the total) savings were realized.
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