2. Important cause of
 Additional morbidity
 Prolonged hospitalization
 Mortality &Increased cost of
hospitalization
Can occur in all hospitalised children
but most common in PICU & NICU

3.  Any infection
that is not
present or
incubating at
the time the
patient is
admitted to the
hospital

4.  INFECTIONS THAT OCCUR AS CONSEQUENCE
OF medical care whether or not they arise
during hospitalisation
 Infections are considered nosocomial if they
first appear 48 hours or more after hospital
admission or within 30 days after discharge

5.  According to NNIS system of USA
 14/100 Discharges in NICU’S
 6/100 Discharges in PICU’S

6. • Portal of Entry
• Susceptible Host
• Causative Agent
• Reservoir
• Portal of Exit
• Mode of Transmission
6

7. 7

8. 1. Catheter related blood stream infections
(CR-BSI)
2. Urinary tract infections (UTI)
3. Ventilator related pneumonia (VAP)
4. Surgical site infections (SSI)
5. Burns infections

9.  host factors,
 prior invasive procedures
 , use of catheters and other devices,
 use of antibiotics
 and exposure to other patients visitors, or
health care providers with contagious
diseases
 LENGTH OF HOSPITALISATION
 INFECTION CONTROL PROGRAMM IN THE
HOSPITAL

10. Factors
Environment
Microbes
Host characteristics
Indwelling devices

11.  URTI
 GIT INFECTIONS
 SKIN & SOFT TISSUE INFECTIONS
 VARIOUS EXANTHEMAS
 As consequence of invasive procedures
 UTI’S ; PNEUMONIA; BACTEREMIA;SURGICAL
SITE

12.  AIR BORNE
 DROPLET
 CONTACT TRANSMISSION
 COMMON VEHICLE
 VECTORS
 AUTO INFECTION

13.  AIR BORNE TINY DROPLETS
pTB,
measles,varicella,legionnaires,aspirgillosis &
mucormycosis
 Droplet transmission
pertusis,meningococcal infections,
 Contact transmission
gram+ cocci, RSV, C.difficile,
enterovirus,hepatitis A

14.  VEHICLE TRANSMISSION
Gram- bacteremia, due contaminated iv
medications,post transfusion infections,
 Auto infection
patients own flora

16.  Host factors that increase the risk for
infection include
 anatomic abnormalities (dermoid sinuses,
cleft palate, obstructive uropathy),
 damage to skin,
 organ dysfunction,
 malnutrition,
 and underlying diseases or co-morbidities

17. Diseases and therapies that alter immunity
are most likely to predispose to infection
Intravenous and other catheters bypass host
defenses, provide direct access to sterile
sites, provide adherence sites for
microbes, and may occlude normal ostia
such as the eustachian tubes.

18.  Antibiotics often alter normal bowel flora
and encourage colonization by resistant
flora,
 and they may suppress hematopoiesis.
 Exposure to adults or children with
contagious diseases is a clear risk for
nosocomial transmission of disease..

19.  Transmission of infectious
agents occurs by various
routes, but by far the most
common and important route is
via the hands

20.  Fungi and resistant bacteria are frequent
causes of infection in immunocompromised
children
 and in those who require intensive care
and prolonged hospitalization

21.  Most effective strategy
 A good hospital infection control program is
must to orchestrate effective infection control
programme

22.  The most important measure in any
infection control programme
 the important component of handwashing
is placement of the hands under water and
use of friction with or without soap.
 Studies show that a 15-second scrub
removes the majority of transient flora but
does not alter the permanent flora.

24.  Alcohol-containing antiseptic hand rubs
preferred except when hands visibly are
soiled with blood or other proteinaceous
materials or if exposure to spores (e.g.,
Clostridium difficile, Bacillus anthracis) is
likely to have occurred
 A chlorhexidine based hand rub has been
recommended as the most suitable for this
purpose

25.  After touching blood, body fluids,
secretions, excretions, or contaminated
items;
 immediately after removing gloves;
 between patient contacts.

27. Compliance < 40%

28. Handwashing …
an action of the past
(except when hands are visibly soiled)
Alcohol-based
hand rub
is standard of care

29. 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
+
+
+
+

The 5 core
components of the
WHO Multimodal
Hand Hygiene
Improvement
Strategy
1. System change

30. - Team and multidisciplinary team work
- Successful interventions
- Adaptability of actions
- Scaling up
- Sustainability of actions / interventions
- Leadership commitment / Governance

31. SAVE LIVES: Clean YOUR
Hands
5 May 2009-2020
A WHO Patient Safety Initiative 2009

32.  formerly known as universal precautions,
are intended to protect health care
workers from blood and body fluids and
should be used whenever providing care
 Standard precautions involve the use of
barriers—gloves, gowns, masks, goggles,
and face shields—as needed to prevent
transmission of microbes associated with
contact with blood or body fluids

33.  Restriction of visitors
 Cleaning
 Rigorous sterilisation
 Disinfection procedures
 Appropriate waste disposal
 Limiting antibiotic therapy
 less invasive procedures
 Preventing hyperglycemia
 Education &training of health workers in inf
control is mandatory

34.  Good surveillance programme to detect
prevailing pattern of pathogens
 Antimicrobial susceptability

35.  Isolation of patients infected with certain
pathogens decreases the risk for
nosocomial transmission
 Contact transmission
 Droplet transmission
 Airborne transmission

36.  RTI
rsv
influenza
parainfluenza virus
GIT infections
viruses
c.difficile
Varicella, measles

37. Use and care of vascular access lines
Use and care of urinary catheters
Therapy and support of pulmonary functions
Experience with surgical procedures

38. Sources of the catheter-associated
bloodstream infection
Skin
Vein
Intraluminal from
tubes and hubs
Intraluminal from
tubes and hubs
Hematogenous
from distant sites
Hematogenous
from distant sites
Extraluminal from
skin
Extraluminal from
skin

39. Multimodal intervention strategies to reduce
catheter-associated bloodstream infections:
- Hand hygiene
- Maximal sterile barrier precaution at insertion
- Skin antisepsis with alcohol-based chlorhexidine-
containing products
- Subclavian access as the preferred insertion site
- Daily review of line necessity
- Standardized catheter care using a non-touch technique
- Respecting the recommendations for dressing change

40. Chlorhexidine
gluconate-
impregnated
sponge
Chlorhexidine
gluconate-
impregnated
sponge

41. Chlorhexidine-Impregnated Sponges and
Less Frequent Dressing Changes for
Prevention of Catheter-Related Infections in
Critically Ill Adults
Multi-centre randomized controlled trial
- 3’778 catheters
- 28’931 catheter-days
- Baseline rate of major catheter-related infections:
1.4/1000 catheter-days!

42. 0.60 per 1000
catheter-days
1.40 per 1000
catheter-days
HR = 0.39;
p=0.03
Chlorhexidine-gluconate impregnated dressings
decreased major catheter-related infections:
Catheter-days
CumulativeRisk
Control
dressings
Control
dressings
ChG
dressings
ChG
dressings

43. Use and care of vascular access lines
Use and care of urinary catheters
Therapy and support of pulmonary functions
Experience with surgical procedures

44. • Urinary tract infection (UTI) causes
~ 40% of hospital-acquired infections
• Most infections due to urinary catheters
• 25% of inpatients are catheterized
• Leads to increased morbidity and costs

45. Avoid unnecessary catheterization
Two main principles
Limit the duration of catheterization

46.  Practice hand hygiene
 before insertion of the catheter
 before and after any
manipulation of the catheter site
http://www.who.int/gpsc/tools/en/

47.  Insert catheters by use of aseptic technique and sterile
equipment
 Cleanse the meatal area with antiseptic solutions is
unnecessary
 routine hygiene is appropriate
 Properly secure indwelling catheters after insertion to
prevent movement and urethral traction
 Maintain a sterile, continuously closed drainage system
 Do not disconnect the catheter and drainage tube unless
the catheter must be irrigated

48.  Do not use (avoid) catheter irrigation
 Do not use systemic antimicrobials routinely as
prophylaxis
 Do not change catheters routinely

49. Use and care of vascular access lines
Use and care of urinary catheters
Therapy and support of pulmonary functions
Experience with surgical procedures

50. Patient
 Age
 Burns
 Coma
 Lung disease
 Immunosuppression
 Malnutrition
 Blunt trauma
Devices
 Invasive ventilation
 Duration of invasive
ventilation
 Reintubation
 Medication
 Prior antiobiotic
treatment
 Sedation

51.  Staff education, hand
hygiene, isolation
precautions
 Surveillance of infection
and resistance with timely
feedback
 Adequate staffing levels

52. Effect of staffing level in late onset VAP

53.  Avoid intubation and reintubation
 Prefer non-invasive ventilation
 Prefer orotracheal intubation & orogastric
tubes -
 Continous subglottic aspiration
 Cuff pressure > 20 cm H2O
 Avoid entering of contaminate consendate
into tube/nebulizer
 Use sedation and weaning protocols to
reduce duration
 Use daily interruption of sedation and avoid
paralytic agents -

54.  Oral chlorhexidine application reduces VAP in
one study but not for general use

55.  Selective decontamination of the digestive tract
(SDD) reduces the incidence of VAP & helps to
contain MDR outbreaks
 But SDD not recommended for routine use
 Prior systemic antibiotics helps to reduce VAP in
selected patient groups but increases MDR
 24-hour AB prophylaxis helps in one study but
not for routine use

56. 1. Adherence to hand hygiene
2. Adherence to glove and gown use
3. Backrest elevation maintenance
4. Correct tracheal-cuff maintenance
5. Orogastric tube use
6. Gastric overdistention avoidance
7. Good oral hygiene
8. Elimination of non-essential tracheal suction
2 year intervention
study:
Compliance with
preventive
measures
increased
VAP prevalence
rate decreased
by 51%

57. 1. Hand hygiene before and after patient contact,
preferably using alcohol-based handrubbing
2. Avoid endotracheal intubation if possible
3. Use of oral, rather than nasal, endotracheal
tubes
4. Minimize the duration of mechanical ventilation
5. Promote tracheostomy when ventilation is
needed for a longer term
6. Glove and gown use for endotracheal tube manip

58. Use and care of vascular access lines
Use and care of urinary catheters
Therapy and support of pulmonary functions
Experience with surgical procedures

59.  Objectives
Reduce the inoculum of bacteria at the surgical site
 Surgical Site Preparation
 Antibiotic Prophylaxis Strategies
Optimize the microenvironment of the surgical site
Enhance the physiology of the host (host defenses)
 In relation to risk factors, classified as
Patient-related (intrinsic)
Pre-operative
Operative

60.  Diabetes - Recommendation
Preoperative
 Control serum blood glucose; reduce HbA1C levels to <7% before
surgery if possible
Post-operative (cardiac surgery patients only)
 Maintain the postoperative blood glucose level at less than 200
mg/dL (A-I)
• Smoking
- Rationale
– Nicotine delays wound healing
– Cigarette smoking = independent RF for SSI after cardiac surgery
- Studies: None
- Recommendation
– Encourage smoking cessation within 30 days before procedure

61. Hair removal technique
Preoperative infections
Surgical scrub
Skin preparation
Antimicrobial prophylaxis
Surgeon skill/technique
Asepsis
Operative time
Operating room characteristics

62.  Recommendations
 Administer within 1 hour of incision to maximize
tissue concentration
 Once the incision is made, delivery to the wound is
impaired

63.  Duration of prophylaxis (A-I)
 Stop prophylaxis
 within 24 hours after the procedure
 within 48 hours after cardiac surgery
 To:
 Decrease selection of antibiotic resistance
 Contain costs
 Limit adverse events

64.  Excellent surgical technique reduces the risk
of SSI
 Includes
Gentle traction and handling of
tissues
Effective hemostasis
Removal of devitalized tissues
Obliteration of dead spaces
Irrigation of tissues with saline
during long procedures
Use of fine, non-absorbed
monofilament suture material
Wound closure without tension
Adherence to principles of asepsis

65. ryryry
Making healthcare safe

66. THANK YOU