Infection occurring in a patient in a hospital or other health care facility in whom the infection was not present or incubating at the time of admission.

1. HEALTHCARE ASSOCIATED INFECTION
(HOSPITAL – ACQUIRED INFECTION)
(NOSOCOMIAL INFECTION)
Dr. Dalia El-Shafei
Assist.Prof., Community Medicine Department, Zagazig University
http://www.slideshare.net/daliaelshafei

2. LEARNING OBJECTIVES
1) To understand the meaning of Healthcare Associated Infection.
2) To recognize the magnitude of the problem especially in developing
countries.
3) To understand the epidemiology of Healthcare Associated Infection

5. DEFINITION: WHO Infection occurring in a patient in
a hospital or other health care
facility in whom the infection
was not present or incubating at
the time of admission.
Infections acquired in the
hospital but appearing after
discharge.
Occupational infections among
staff of the facility.

6. MAGNITUDE OF THE PROBLEM
Each year, hundreds of millions of patients around
the world are affected by HAI.
Several folds higher in low- & middle-income
countries than in high-income ones.
Incidence ranges between 10-30% in developing
countries in contrast to 5-10% in developed countries.

7. HAI RESULTS IN:
↑
Hospital
stay
↑
Long-term
disability
↑
Resistance
of to anti-
microbials
↑
Costs
↑
Mortality

8. ORGANIZATION STRUCTURE FOR IC IN MOH “EGYPT”
IC department follow Prevention section of MOH sections
IC department present in each governorate of Egypt
IC specialist doctor should be present inside each hospital all
over districts
IC specialist lead infection control activities inside hospitals
& direct IC unit inside hospitals & act as leader for IC team
IC team: IC specialist “leader”, IC head nurse, nurse
coordinator inside each of hospital department

9. ACTIVITIES CARRIED BY IC TEAM:
Setting IC
policies &
strategies
Training of
all staff on
IC standards
Follow up &
evaluate IC
performance
Document
of IC
activities
inside
hospital
Notification
to IC
authorities
at MOH
Surveillance
both active
& passive
for all
diseases &
HAIs
Help in
Epidemic
containment
activities as
part of
national
team

10. -‫تم‬‫إنشاء‬‫اإلدارة‬‫العامة‬‫لمكافحة‬‫العدوي‬‫التابعة‬‫لقطاع‬‫الطب‬‫الوق‬‫ائي‬
‫بالوزارة‬‫التابع‬‫ويتبعها‬‫إدارات‬‫مكافحة‬‫العدوي‬‫بمديريات‬‫الشئ‬‫ون‬‫الصحية‬
،‫بالمحافظات‬‫وتشكيل‬‫فرق‬‫مكافحة‬‫العدوي‬‫بالمستشفيات‬‫ومر‬‫اكز‬
‫الرعاية‬‫واإلدارات‬‫الصحية‬‫لإلشراف‬‫علي‬‫تنفيذ‬‫برنامج‬‫مكافحة‬‫ا‬‫لعدوي‬.
‫وتم‬‫إصدار‬‫الدليل‬‫القومي‬‫واألدلة‬‫اإلرشادية‬‫والملصقات‬‫والمطبوعا‬‫ت‬
‫الخاصة‬‫بمكافحة‬‫العدوي‬،‫وتدريب‬‫إدارات‬‫وفرق‬‫ومسئولي‬‫مكافحة‬
‫العدوي‬‫بالمديريات‬‫الصحية‬،‫والمستشفيات‬‫وتدريب‬‫كافة‬‫مقدم‬‫ي‬‫الخدمة‬
‫الطبية‬‫علي‬‫معايير‬‫مكافحة‬‫العدوي‬‫العامة‬‫مع‬‫التركيز‬‫علي‬‫األقس‬‫ام‬‫ذات‬
‫الطبيعة‬‫الخاصة‬.
‫وانشأ‬‫القطاع‬‫منظومة‬‫لترصد‬‫عدوي‬‫المستشفيات‬ً‫وفقا‬‫للمعايي‬‫ر‬‫العالمية‬
‫ووضعت‬‫معايير‬‫وقائية‬‫للحد‬‫منها‬‫لضمان‬‫تقديم‬‫خدمة‬‫طبية‬‫آمنة‬‫ل‬‫لمواطن‬
‫المصري‬‫ومنع‬‫انتشار‬،‫الميكروبات‬‫ومنظومة‬‫اخري‬‫لترشيد‬‫استه‬‫الك‬
‫المضادات‬‫الحيوية‬‫وتم‬‫اعتماد‬‫خطة‬‫قومية‬‫لمجابهة‬‫الميكروبات‬‫المق‬‫اومة‬
‫للمضادات‬.

11. 1 LE
Infection Control
150-200 LE
HAI
In Egypt
Saves

13. RESERVOIRS OF INFECTION
Patient [
cross-
infection or
endogenous
infection]
Health care
providers
Visitors Objects or
substance
recently
contaminated
(environ-
mental
transfer)
Insects &
vectors

14. MODES OF TRANSMISSION:
Contact
• Direct:
physical
contact
between 2
individuals
• Indirect:
involves
inanimate
objects
Droplet
• During
coughing &
sneezing or
respiratory
tract
procedures as
bronchoscopy
or suction.
Airborne
• Tiny droplet
nuclei <5
micron that
remain
suspended in
air.
Vehicle
• Transmission
of pathogens
through
(vehicles)
indirectly
such as water,
food, and air.
Vector
• When
pathogen
reproduces
within a
biological
vector that
transmits it
from one host
to another
(insects
mainly) or
invertebrate
animal

15. PORTAL OF EXIT:
Respiratory Gastrointestinal Genitourinary
Skin & mucous
membrane

16. AT RISK
Extremes of age
↓Immunity, DM,
Cortisone ttt
Major surgery,
orthopedic surgery
ICU, after intubation
or endoscopy or
invasive maneuvers.
Obesity, bed sores,
Mechanical ventilator
Hospitalization for
long time before
operation.

17. COMMON TYPES OF HAIS
Urinary
tract
infections
Surgical site
infections
Blood
stream
infection
(septicemia)
Hospital
acquired
pneumonia

19. PREVENTION OF HAIS:
Primary prevention:
• Sanitation of hospital environment.
• Isolation of infectious cases.
• Incineration of hospital wastes.
• Disinfection of surgery rooms by UVRs, limiting no. of personnel in operative room.
• Providing washing, sterilization facilities in hospital.
• Strict IC instructions for HCWs.
• Control of visitors.
• Use disposable syringes & Safe blood-transfusion.
• Examination of HCWs for staph or strept. carrier.
• Prophylactic use of broad spectrum antibiotics in pre, intra and postoperative care.

20. Hand washing before & after patient contact prevents 80% of infection.
It is very simple method of prevention but it is very effective.

21. SECONDARY PREVENTION:
• Early detection of cases by frequent monitoring of temperature & signs of infection
• Proper ttt by antibiotics.
• Search for the reservoir (case or carrier or environment)
• Management of these reservoirs to prevent more spread (outbreaks).
• Drastic measures: if a case of tetanus or gas gangrene appears in any surgical room.
• All operative rooms should be closed (all operations are postponed) till complete
sterilization (concurrent & terminal disinfection) proved by free lab exam.

22. TERTIARY PREVENTION:
Rehabilitation
Compensation
One of the patient's rights is to take safe medical care.