infection control measure for health care workers

1. HEALTHCARE ASSOCIATED
INFECTION
Dr. Anjalatchi Muthukumaran
Vice principal
Era college of Nursing

2. Health Care-Associated Infections (HAI)
According to WHO:
■ HAI is also called “nosocomial”.
■ “nosus” = disease
■ “komeion” = to take care
■ HAI is defined as:
– 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
nor in the incubation period at the time of admission.
– the symptom should appear at least 48 hrs of admission

3. This also includes :-
■ Infections that are acquired in the Hospital but
symptoms appear after discharge.
■ Occupational infections among staff of the healthcare
facility ( e.g. needle stick injury transmitted infections)

4. ■ Opportunistic infection:- Infection with organisms that
are normally commensals in the Human but become
pathogenic when the body’s immunological defenses are
compromised like in AIDs patients.
■ Iatrogenic disease:- It is “doctor-generated” that
occurs due to adverse effects of treatment,
prevention, diagnosis, surgical procedures, etc

5. Factors Affecting HAI
■ Immune status
■ Hospital environment
■ Hospital organisms
■ Diagnostic or therapeutic interventions
■ Transfusion
■ Poor hospital administration

6. Sources of HAIs
■ Endogenous source- Caused by the organisms that are
present as part of normal flora of the patient
■ Exogenous source-
o Environmental sources
o Health care workers
o Other patients

7. Microorganisms implicated in HAIs
■ The ESKAPE pathogens-
o Enterococcus faecium
o Staphylococcus aureus
o Klebsiella pneumoniae
o Acinetobacter baumannii
o Pseudomonas aeruginosa
o Enterobacter species and Escherichia coli

8. Other infections that can spread in hospitals include:-
■ SARS-CoV-2
■ Nosocomially acquired Mycobacterium tuberculosis
■ Legionella pneumophila
■ Clostridium difficile diarrhoea
Blood Borne infection
■ HIV
■ Hepatitis B
■ Hepatitis C viruses
 Transmitted by
o Blood Transfusion
o Needle /Other Sharp Injury /Splash

9. MAJOR TYPES OF HAIs
■ Catheter-associated urinary tract infection (CAUTI)
■ Central line-associated blood stream infection (CLABSI)
■ Ventilator-associated pneumonia (VAP)
■ Surgical site infection (SSI).

10. Catheter-associated
urinary tract infection
(CAUTI)

11. CDC definition of CAUTI
Catheter associated urinary tract infection is defined when all the
following criteria is present.
1. Patient had an indwelling urinary catheter that had been in place for >
2 consecutive days in an inpatient location on the date of event AND was
either present for any portion of the calendar day on the date of event
or removed the day before the date of event.
2. Patient has at least one of the following signs or symptoms: Fever
(>38.0°C), Suprapubic tenderness, Costovertebral angle pain or
tenderness, Urinary urgency, Urinary frequency, Dysuria
3. Patient has a urine culture with no more than two species of organisms
identified, at least one of which is a bacterium of ≥105 CFU/ml

13. Causative organisms
■ Escherichia coli, Candida spp, Enterococcus spp,
Pseudomonas aeruginosa , Klebsiella
pneumoniae, Enterobacter spp.
■ A smaller proportion was caused by other gram-
negative bacteria and Staphylococcus spp.

14. Risk factors
■ Advanced age
■ Female gender
■ Severe underlying disease
■ Placement of a urinary catheter for > 2 days.

15. Central line associated-
blood stream infection
(CLABSI)

16. “Laboratory-confirmed bloodstream infection
with a Central Line in place for >2calendar
days on the date of event (DOE) AND the line
was in place on the DOE or the
day before = CLABSI”
Definition of CLABSI

17. Causative Agents:-
Gram-positive organisms (coagulase-
negative Staphylococci), Enterococci,
Staphylococcus aureus,
Gram negative micro-organisms,
(Klebsiella, Enterobacter, Pseudomonas, E.
coli, Acinetobacter spp.),
Candida species

18. Source of CLABSI
■ Migration of skin organisms at the insertion site into the
cutaneous catheter tract and along the surface of the
catheter with colonisation of the catheter tip. This is
the most common route of infection for short term
catheters
■ Direct contamination of the catheter or catheter hub by
contact with hands or contaminated fluids or devices
■ Contaminated infusate may lead to CLABSI though this
is rare.

19. Routes for contamination of catheters leading to
blood stream infection.

20. Risk factors
■ Patient related:
o Age (<1 yr and >60 yrs), malnutrition
o Low immunity
o Severe underlying disease
o Loss of skin integrity (burn or bed sore)
o Prolonged stay in ICUs
■ Device related: presence of central line : multi-lumen, non-
tunnelled
■ HCW related: poor IC practices such as Hand Hygiene

21. SSI is classified as following:-

22. Superficial incisional SSI: Must meet the following
criteria:
■ Date of event occurs within 30 days after any operative
procedure (where day 1 = the procedure date) AND involves only
skin and subcutaneous tissue of the incision
AND
■ patient has at least one of the following:
■ Purulent drainage from the superficial incision.
■ Organism(s) identified from an aseptically-obtained specimen
from the superficial incision or subcutaneous tissue by a culture
testing method which is performed for purposes of clinical
diagnosis or treatment.
■ In case culture not done…..at least one of the following signs or
symptoms: localized pain or tenderness; localized swelling;
erythema; or heat.
■ Diagnosis of a superficial incisional.

23. Deep incisional SSI must meet the following criteria:
■ The date of event occurs within 30 or 90 days after operative procedure
(where day 1 = the procedure date)
■ involves deep soft tissues of the incision (for example, fascial and
muscle layers) AND
■ Patient has at least one of the following:-
■ Purulent drainage from the deep incision.
■ Deep incision that spontaneously dehisces, or is deliberately opened or
aspirated by a surgeon, AND organism(s) identified from the deep soft
tissues of the incision by a culture testing method which is performed
for purposes of clinical diagnosis or treatment
■ A culture that has a negative finding does not meet this criterion.
AND
■ patient has at least one of the following signs or symptoms: fever
(>38°C); localized pain or tenderness.
■ An abscess or other evidence of infection involving the deep incision
that is detected on gross anatomical or histopathologic exam, or imaging

24. ■ Pathogenesis:
■ Endogenous:
– Patient flora: skin ,mucous membranes, GI tract
– Seeding from a distant focus of infection
■
■ Exogenous
■ Surgical Personnel (surgeon and team)
■ Soiled attire
■ Breaks in aseptic technique
■ Inadequate hand hygiene
■ Physical environment and ventilation
■ Tools, equipment, materials brought to the operative
field

25. Organisms Causing SSI:
■ Staphylococcus aureus,
■ Coagulase-negative staphylococci,
■ Enterococcus spp.,
■ Escherichia coli,
■ Pseudomonas aeruginosa,
■ Enterobacter spp,
■ Klebsiella pneumoniae,
■ Candida spp.,
■ Klebsiella oxytoca, Acinetobacter baumannii.

26. ■ Risk factors for nosocomial wound infection include:
o Advanced age, obesity, malnutrition, diabetes
o Infection at a remote site that spread through blood
stream
o Preoperative shaving of the site
o Inappropriate timing of prophylactic antimicrobial
agent.
o Note: -The antimicrobial prophylaxis is usually
given to the patient to prevent the seeding of
organisms on the surgical site. It is given 1 hour
prior to the incision, usually along with the
induction of anesthesia.

27. Ventilator associated pneumonia

28. What is VAP?
■ A pneumonia where the patient is on
mechanical ventilation for >2 calendar days
on the date of event, with day of ventilator
placement being Day 1, AND Ventilator was in
place on the date of event or the day before.

29. Pathogenesis
■ Exogenous source:- Hands of health care
worker, Contaminated ventilator circuit,
endotracheal intubation.
■ Endogenous source:- Colonization of oropharynx
and nasopharynx

30. Causative organisms
■ Klebseilla pneumonea,
■ E.coli,
■ Staphylococccus sps,
■ Citrobacter sps,
■ Pseudomonas sps etc

33. Risk factors for VAP
■ Patient related:
– Prolonged ICU stay leading to colonization of
hospital MDROs
– Aspiration of oropharyngeal flora due to various
reasons such as semiconscious state, supine
position etc
■ HCW related: poor IC practices such as Hand

34. Impacts of Health Care-Associated
Infections (HAI)
HAI can:
 Increase patients’ suffering.
 Lead to permanent disability.
 Lead to death.
 Prolong hospital stay.
 Increase need for a higher level of care.
 Increase the costs to patients and hospitals.

35. How can HAI prevented?
Requires health care providers who have:-
 Knowledge of common infections and their vectors
 An attitude of cooperation and commitment
 Skills necessary to provide safe care

36. Required Skills
 Apply universal precautions
 Use personal protection methods
 Know what to do if exposed
 Encourage others to use universal precautions
 Report breaks in technique that increase patient risks
 Observe patients for signs and symptoms of infection

37. Universal precautions:-
 "Universal precautions," as defined by CDC, are a set of
precautions designed to prevent transmission of human
immunodeficiency virus (HIV), hepatitis B virus (HBV), and other
bloodborne pathogens when providing first aid or health care.
Under universal precautions, blood and certain body fluids of all
patients are considered potentially infectious for HIV, HBV and
other bloodborne pathogens

38. Use of Personal Protective Equipment
 Gloves
 aprons
 Gowns
 eye protection
 face masks
 Health care workers should wear a face mask,
eye protection and a gown if there is the
potential for blood or other bodily fluids to splash.

39. One more important thing!
Protect Yourself
Be sure you have been immunized
against Hepatitis B since it is very easy
to transmit!

40. Ways to Prevent HAI
1. Maintain cleanliness of the hospital.
2. Personal attention to handwashing before and after every
contact with a patient or object.
3. Use personal protective equipment whenever indicated.
4. Use and dispose of sharps safely.
5. Sterilization of reusable equipments
6. judicious use of antibiotics may reduce the prevalence of
multidrug-resistant organisms in health care facilities.

41. Prevention of Catheter-Associated Urinary
Tract Infection (CA-UTI)
Avoid unnecessary catheterization
Two main principles
Limit the duration of catheterization

42. Prevention through Handwashing
Hands are the most common vehicle for transmission of
organism and “hand hygiene” is the single most effective
means of preventing the horizontal transmission of
infections among hospital patients and health care personnel.

43. World Health Organizations (WHO′s) five moments for
hand hygiene:-
 Before patient contact
 Before an aseptic task
 After body fluid exposure even if wearing gloves!
 After patient contact
 After contact with patient surroundings

44. Your 5 moments for HAND HYGIENE

45. How to Clean Hands
 Remove all wrist and hand jewelry.
 Cover cuts and abrasions with waterproof dressings.
 Keep fingernails short, clean, and free from nail
polish.

46. Alcohol-based
handrub at point of
care
Access to safe,
continuous water
supply, soap and
towels
2. Training and Education
3. Observation and feedback
4. Reminders in the hospital
5. Hospital safety climate
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■ The 5 core
components of the
WHO Multimodal
Hand Hygiene
Improvement
Strategy
1. System change

47. Multidisciplinary team
approach
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Pittet D, Am J Infect Control 2005, 33:258

48. Campaigns to Decrease Infection Rates
WHO “Clean hands are safer hands” campaign
Centers for Disease Control and Prevention (CDC)
“prevent antimicrobial resistance’’ campaign in
health-care settings
Institute for Healthcare Improvement (IHI) “5 million
lives” campaign
Developing country focuses

50. THANK YOU