2. DEFINITION
Infections that develop within a hospital or
are produced by microorganisms,acquired
during hospitalization, within 48hrs.
Also called as “NOSOCOMIAL
INFECTIONS.”
‘Nosus’ means disease.
‘Kameion’ means to take care of.
3. DEFINITION BY C.D.C
Infections that the patients
acquire during the course of
receiving treatment for other
conditions, or acquired by the
Healthcare Workers while
performing their duties in
healthcare settings.
4. Public health importance
Major public health problem
Incidence -2% to 12% in developed countries
The incidence depends on type of hospital,
type of patients and type of surgeries
performed
5. STATUS IN INDIA
Risk of infections in India.
[Current scenerio as per apiindia.org]
Approx. 19,900 neonatal deaths/year due to sepsis.
5-10% of patients admitted to acute care hospitals acquire
infections.
2 million patients/year affected.
90,000 deaths/year
1/4th of nosocomial infections occur in ICUs.
70% are due to antibiotic resistant organisms
8. SOURCES OF INFECTION
2 SOURCES :
EXOGENOUS
• Outside the human
body
ENDOGENOUS
• By Normal human
flora
9. • Caused by organisms
acquired by exposure
to hospital personnel,
medical devices or
hospital environment.
EXOGENOUS
INFECTIONS
• Caused by organisms
that are present as a
part of normal flora of
the patient.
ENDOGENOUS
INFECTIONS
10.
11. Richards, MJ. 1999. Crit Care Med 27; 887.
0
5
10
15
20
25
30
35
Overall ICU
UTI
Pneumonia
SWI
Bloodstream
Other
15. SURGICAL SITE
INFECTIONS
Any purulent discharge, abscess,
or spreading cellulitis at the
surgical site during the month after
the operation.
The infection is usually acquired
during the operation itself; either
exogenously (e.g. from the air,
medical equipment, surgeons and
other staff), endogenously from
the flora on the skin or in the
operative site or, rarely, from blood
used in surgery
16. URINARY TRACT
INFECTIONS
Positive urine culture (1 or
2 species) with at least 105
bacteria/ml, with or
without clinical symptoms.
MOST COMMON
NOSOCOMIAL INFECTION
80% of infections are
associated with the use of
an indwelling bladder
catheter
17. RESPIRATORY INFECTION
Respiratory symptoms with
at least two of the following
signs appearing during
hospitalization:
Cough
Purulent sputum
New infiltrate on chest
radiograph consistent with
infection.
18. BLOOD STREAM
INFECTIONS
Represent a small
proportion of nosocomial
infections.
Case fatality : >50%
Organisms involved :
Multi resistant coagulase-
negative Staphylococcus
Candida spp.
25. ADMINISTRATIVE MEASURES
Formation of a hospital aquired “
INFECTION CONTROL COMMITTEE” to
formulate the policies regarding admission
of infectious cases, isolation facilities &
disinfection procedures.
Formation of a CSSD (Central Sterile
Supply Department) in every hospital.
26. Infection Control Committee
The hospital ICC is charged with
the responsibility for the
planning, evaluation of
evidenced-based practice and
implementation, prioritization
and resource allocation of all
matters relating to infection
28. Role of infection control
teams
Education and training
Development and dissemination of infection
control policy
Monitoring and audit of hygiene
Clinical audit
29. C.S.S.D (Central Sterile Supply
Department)
Supply of sterile instrument & material for
dressing & procedure carried out in the
wards and departments.
Sterilization of instruments & linen for use
in O.T.
Disinfection & Sterilization of medical
equipment.
Selection & distribution of single use sterile
30. Goals of infection control
Ensure that health professionals understand
how pathogens can be transmitted in the
working environment [patient to healthcare
worker, healthcare worker to patient &patient
to patient]
Apply current scientifically accepted infection
control principles
Minimize opportunity for transmission of
pathogens to patients and healthcare workers
31.
32. ISOLATION
Infectious patients MUST be isolated.
Patients susceptible to infection should not
be placed in the beds next to patients who
are a source of infection.
33. MEASURES BY HOSPITAL
STAFF
Those suffering from infectious ailments
should be kept away from work until
completely cured.
They should be careful about PERSONAL
HYGIENE.
Aprons & Outer clothing should be
regularly changed.
35. HAND HYGIENE
HANDS ARE THE MOST IMPORTANT VEHICLES OF HAI TRANSMISSION
• THOUSANDS OF PEOPLE DIE EVERYDAY FROM INFECTIONS WHILE RECEIVING HEALTH
CARE
• MOST IMPORTANT MEASURE TO AVOID THE TRANSMISSION OF HARMFUL
MICROORGANISMS.
ANY HEALTHCARE WORKER/PERSON INVOLVED IN DIRECT/INDIRECT
PATIENT CARE
WHY?
WHO?
39. WHY DON’T STAFF WASH
HANDS?
• THE COMPLIANCE ESTIMATED IS LESS
THAN 50%
• SKIN IRRITATION
• WEARING GLOVES
• TOO BUSY FOR REGULAR HAND WASHING
• LACK OF APPROPRIATE STAFF
• Being a physician
40. DUST CONTROL
Dust is released during SWEEPING,
DUSTING & BEDMAKING.
Suppression by WET DUSTING
VACUUM CLEANING
41. PROPER DISPOSAL OF
HOSPITAL WASTE
COLOR WASTE TREATMENT
YELLOW Human & animal anatomical
waste/Microbiology waste and soiled
cotton/dressings/linen/bedding etc.
INCINERATION/ DEEP
BURIAL
RED Tubing/catheters/i.v. sets etc. AUTOCLAVE/MICROW
AVE/CHEMICAL
TREATMENT
BLUE/
WHITE
Waste sharps
(needles,syringes,scalpels,blades etc.)
AUTOCLAVE/MICROW
AVE/CHEMICAL
TREATMENT/
DESTRUCTION
BLACK Discarded medicines/
cytotoxic drugs/incineration
ash/chemical waste
DISPOSAL IN LAND
FIELDS
42. DISINFECTION
Disinfection prevents transmission of
organisms between patients.
3 LEVELS OF DISINFECTION:
HIGH LEVEL - destroys all the microorganisms except heavy
contamination by bacterial spores.
INTERMEDIATE LEVEL – inactivates M.tuberculosis, vegetative
bacteria, most viruses & fungi.
LOW LEVEL – kills most bacteria, some viruses & some fungi.
43. STERILISATION
Operationally, defined as decrease in
microbial load to 10-4.
Done for
Medical devices penetrating sterile body sites
Parenteral fluids
Medications
Reprocessed equipment
The objects must be wrapped after
sterilization to maintain its viability for
longer durations of time.
44. CONTROL OF DROPLET
INFECTION
Use of face-mask
Proper bed-spacing
Prevention of overcrowding
Ensure adequate ventilation
45. IMPROVING NURSING
TECHNIQUES
BARRIER NURSING is the effective
measure.
Its Aim is to protect medical staff against
infection by patients, especially with highly
infectious diseases.
46. An attempt should be made to achieve and
maintain an average count of 10-15
bacteria/cubic foot of air in hospital.
Less than 5 bacteria/cubic foot – minimal
risk of infection.
More than 35 bacteria/cubic foot – high risk
of infection
47. Guideline to evaluate the floor
cleaning procedure
based on REPLICATE ORGANISM
DETECTION &COUNTING (R.O.D.A.C plate
count)
0-25 bacteria/cubic foot - good floor
cleaning procedure.
26-50 bacteria/cubic foot – satisfactory.
>50 bacteria/cubic foot – not satisfactory.
57. BIBLIOGRAPHY
Park’s Textbook of Preventive & Social
Medicine 23rd edition
Prevention of Hospital Acquired Infections
WHO GUIDELINES
Bennett and Brachman’s Hospital Acquired
Infections by William R. Jarvis
CDC – www.cdc.gov/cdc.htm
Harrisons textbook of medicine 18/e pg 1112
Hospital Administration by Francis & de ’Souza
Instruments Picture from saifaee medical college
Etawah, website
