hAI and role of nurses

1. HOSPITAL ACQUIRED INFECTION

2. INTRODUCTION
Healthcare associated infections are one of the
most common adverse events in the care
delivery system. According to WHO on average
at any given time 7% of patients in developed
and 10% in developing countries acquire at
least one HAI. Mortality from HAI occurs in
about 10% of affected patients.

3. DEFINITION
Healthcare associated infections can be defined
as
1. Infections acquired in the hospital by a
patient admitted for a reason other than the
infection in contex
2. Infection should not be present or incubating
at the time of admission
3. The symptoms should appear at least after
48 hours of admission

4. This also includes :
I. Infections that are acquired in the hospital
but symptoms appear after discharge
II. Occupational infections among staff of the
health care facility.
III. Infection in neonate that results while
passage through the birth canal

5. FACTORS AFFECTING HAI
• IMMUNE STATUS

6. • HOSPITAL ENVIRONMENT

7. • HOSPITAL ORGANISMS

8. • DIAGNOSTIC AND THERAPEUTIC
INTERVENTIONS

9. • TRANSFUSION

10. • POOR HOSPITAL ADMINISTRATION

11. SOURCE OF INFECTION
Endogenous source
The majority of HAI are endogenous in origin
which involve patient’s own flora which may
invade the patient’s body during some surgical
or instrumental manipulations

12. Exogenous source
It is from the hospital environment, health care
workers or patients

13. MICRO ORGANISMS IMPLICATED IN
HAI
HAIs can be caused by almost any micro
organisms but those which survive in the
hospital environment for long periods and
develop resistance to anti microbial and
disinfectants are particularly important

14. ESKAPE PATHOGENS
• Enterococcus faecium
• Staphylococcus aureus
• Klebsiella pneumoniae
• Acinetobacter baumannii
• Pseudomonas aeruginosa
• Enterobacter species

15. Other pathogens include:
• Escherichia coli
• SARS-COV-2
• M.Tuberculi
• Legionella pneumophilia
• Candida albicans
• Clostridioides difficile diarrhoea
• HIV ,Hep B, Hep C

16. MODE OF TRANSMISSION
Mode of transmission include
• Contact
• Droplet
• Airborne transmission

17. MAJOR HAI TYPES
• Catheter associated urinary tract infections
• Central line associated blood stream infections
• Ventilator associated pneumonia
• Surgical site infection

18. CARE BUNDLE

19. PREVENTION OF UTI ( CAUTI)
Insertion bundle
• Catheter should be inserted only when
appropriate indication is present
• Only the sterile items are used for insertion of
catheter
• Catheter is inserted by non touch technique with
strict asepsis
• Catheter of appropriate size must be used
• Catheter must be properly secured after
placement

20. Maintenance bundle
• Daily catheter care must be given regularly
and by strict aseptic measures such as hand
hygiene and single use gloves
• Catheter is properly secured all the times
• Drainage bag must be always above the floor
and below bladder level
• Closed drainage system is used all the time

21. Contd
• While collection of urine from bag, the
following steps must be followed: hand
hygiene, change of gloves between patients,
use of separate jug for each bag , use of
alcohol swab for disinfecting of outlet
• Daily assessment of readiness for removal of
catheter must be documented.

22. CARE BUNDLE FOR CENTRAL LINE
ASSOCIATED BLOOD STREAM
INFECTION (CLABSI)

23. Insertion bundle
• Hand hygiene before and after insertion of
central line
• Use maximum sterile PPE
• Site of insertion – subclavian preferred and
femoral is avoided
• Skin preparation- by antiseptics such as
chlorhexidine

24. • Skin must be completely dry after use of
antiseptics
• Use semi permeable dressing
• Document date and time of insertion

25. Maintenance bundle
• Daily aseptic central line care during handling
• Daily documentation of local signs of
infections
• Daily assessment of readiness for removal of
central line must be documented

26. Maintenance care bundle for
VENTILATOR ASSOCIATED PNEUMONIA
( VAP)
• Adherence to hand hygiene
• Elevation of the head of the bed to 30-45 degree
• Daily oral care with chlorhexidine solution 2%
solution
• Need of PUD( peptic ulcer disease) prophylaxis
should be assessed daily
• DVT prophylaxis
• Daily assessment with readiness to remove
mechanical ventilator must be documented

27. PREVENTION FOR SURGICAL SITE
INFECTION
Preoperative measures
1. Pre operative bathing: it should be performed using
plain soap or an anti microbial soap to reduce the
bacterial load, especially at the site of incision
2. For MRSA Carriers: decolonization with muciprocin
ointment must be done for patients undergoing
surgery who are nasal carriers of MRSA
3. Hair removal: for patients undergoing any surgical
procedure hair removal should not be done or if
absolutely necessary it should be removed with
clipper.

28. Intra operative measures:
• Surgical anti biotic prophylaxis must be provided
for all times except clean surgeries
• Surgical hand disinfection
• Surgical site preparation
• Perioperative maintenance of oxygen ( target Fi02
80%) and normothermia, blood glucose level ( <
200 mg/dl), normovolemia and nutritional
support are necessary

29. Post operative measures
• Wound dressing
• OT disinfection
• Periodic monitoring of the air quality of
operation theatre
• SAP prolongation is not recommended

30. SURVEILLANCE OF HAI

31. Health care associated infections surveillance is a
system that monitors the HAIs in a hospital. The
main objectives of HAI surveillance include:
• Provides endemic or baseline HAI rate and
information on the type of HAIs in the hospital
• Helps in comparing HAI rates within and between
hospitals
• Identifies the problem areas
• Provides timely feedback to the clinicians

32. TARGETTED SURVEILLANCE
The national healthcare safety network division
of CDC provides guidelines for the surveillance
of HAIs
• Where to conduct
• What type of HAIs to be monitored
• Who will conduct
• HAI surveillance diagnostic criteria

33. METHOD OF COLLECTING HAI
SURVEILLANCE
• Data collection
• Data analysis
• Data interpretation
• Data dissemination

34. HOSPITAL INFECTION CONTROL
COMMITTEE
It is run by the medical superintendent who
he/she constitutes the hospital infection
control committee.

35. FUNCTIONS OF HICC
• HAI surveillance
• Develops a system
• Antimicrobial stewardship program
• Policies
• Education
• Staff health
• Outbreak management
• Other departments co ordination
• Reviews
• HICC meetings

36. RESPONSIBILITY OF DIFFERENT
STAKEHOLDERS OF HICC
Hospital administration
• Establish a multidisciplinary HICC
• Provide adequate resources
• Ensure availability of hand hygiene
• Approve and review policies and guidelines
for infection control practices

37. Infection control officer
The ICO is either a clinical microbiologist or an
infectious disease physician
Duties
• Meticulous planning and implementation of
infection control measures
• Supervises the HAI surveillance activities
• Plays an active role in investigation of the
outbreak

38. • Conducts research related activities
• Supervises the activities of department of
biomedical waste
• Acts as nodal officer for management of
needle stick injury
• Ensure implementation of safe work practices
• Ensures immunization of all HCWs as
recommended

39. • Formulate and implement guidelines for
sterilization of equipments and instruments
• Involves in drawing up annual plans
• Prepares annual budget of HICC
• Conducts regular surveys and surprise visits
• Performs AMR surveillance and disseminates
annual hospital location/department specific
antibiogram

40. • Actively participates in implementing anti
microbial stewardship program and also co
ordinates formulation of anti biotic policy
• Review and revision of infection control
manual.

41. INFECTION CONTROL NURSE
An ICN is a registered nurse with an additional
academic education and practical training in
infection control, clinical and diagnostic
microbiology, epidemiology and computer
technology

42. DUTIES OF ICN
• Carry out data collection of HAI surveillance,
hand hygiene audit, care bundle audit. PPE
audit etc by performing daily visits to ICUs and
wards
• Oversee the implementation of transmission
based precautions whenever necessary
• Monitors the implementation of disinfection
policy at the hospital

43. • Identifies the high risk areas for conducting
environmental surveillance
• Involves in education of healthcare workers and
patients
• Provides post exposure prophylaxis for needle
stick injury cases. They also maintain registers
and data on needle stick injuries
• In a certain healthcare facility, ICNs are also
involved in conducting antimicrobial stewardship
activities

44. INFECTION CONTROL LINKS NURSE
If adequate ICNs are not available, then the
existing nursing staff working in ICUs can be
trained so that they can be part time engaged
in monitoring infection control activities of
their concerned ICUs

45. Some studies have shown that
• A competent infection control links nurse can
motivate ward staff by enabling more effective
practice
• This practice can be very much useful, provided
the link nurses are adequately trained and backed
up by strong infection control team
• Lack of adequate training, frequent turnover of
nurses, lack of recognition of their role are the
problem areas that need to be addressed while
implementing this program.