Hospital acquired infections: The different common sources of infection, their routes of spread and the growing antimicrobial resistance. Also includes a discussion on hospital Infection prevention and control guidelines and the universal and standard precautions.

1. HOSPITAL
ACQUIRED
INFECTION
& its prevention

2. Content
○Hospital acquired infections
○Sources of infection
○Routes of spread
○Antimicrobial resistance
○Hospital Infection Prevention and Control Guidelines
○Universal and standard precautions

3. Hospital acquired infections (HAI)
○HAI are infections acquired during hospital care which
are not present or incubating at admission.
○Infections occurring more than 48 hours after admission
are usually considered nosocomial.

4. Hospital acquired infections (HAI)
○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
healthcare facility in whom the infection was not present
or incubating at the time of admission.
○This includes infections acquired in the hospital but
appearing after discharge, and also occupational
infections among staff of the facility

5. HAI - burden
○HAI occur worldwide and affect both developed and
resource-poor countries.
○Over 1.4 million people worldwide suffer from such
infectious
○Most frequent of these are:
 infections of surgical wounds
 urinary tract infections
 lower respiratory tract infections

6. Why do patients in hospital acquire
infection?
○Patients with infectious diseases are frequently admitted
to hospital.
○Some of these patients are able to spread their
organisms to other patients and they provide one source
of infection in hospital patients admitted for other causes

7. Why do patients in hospital acquire
infection?
○When such patients require admission to hospital, the
risk has to be assessed for other patients.
○Appropriate measures have to be taken to contain the
infection with isolation procedures of varying degrees of
strictness depending on the infection

8. Why do patients in hospital acquire
infection?
○ The commonest forms of HAI are due to invasive
procedures carried out on patients such as:
 surgical operations
 intravenous therapy
 intubation
 catheterization

9. Why do patients in hospital acquire
infection?
○Immunodeficiency of varying degrees is seen in many of
the patients admitted to hospital. These include:
 patients at the extremes of age
 patients with diabetes
 receiving immunosuppressive drugs
 patients with cancer, in particular those undergoing
chemotherapy
These patients are prone to infection with bacteria which
have little threat for healthy persons.

10. Chain of
infection
There are six
elements in the cycle
of infection, and all six
must be present
before the
transmission of
infection can take
place.

11. Chain of
infection

12. Sources of infection in the hospital
Other
patients
Visitors
Water /
food
AirSurgical
procedu
res
Hospital
persons
Devices,
drains
and
catheter
Fomite
contami
nation
Pt’s
normal
flora

13. Sources of infection in the hospital
Exogenous source
○ Other patients (cross-infection)
○ Health care workers
○ Inanimate objects (fomites) vehicle
○ Inanimate environment of the hospital:
 Contaminated air, water, food
 Contaminated equipment and instruments
 Soiled linen
 Hospital waste (Biomedical waste)

14. Sources of infection in the hospital
Endogenous sources
○ source is the normal intestinal flora or colonizers of skin
and other epithelial surfaces

15. Routes of
infection in the
hospital
○IV line

16. Routes of
infection in the
hospital
Catheter

17. Antimicrobial resistance
○Antimicrobial resistance (AMR) is the ability of a microbe
to resist the effects of medication previously used to treat
them
○Resistant microbes are increasingly difficult to treat,
requiring alternative medications or higher doses → which
may be more costly or more toxic

18. Common mechanism of resistance

20. Common infections in ICU

21. CommonpathogensinICU

22. Hospital Infection
Prevention and Control
Guidelines November, 2015
National Center for Disease Control
Directorate General of Health & Family Welfare, Govt of India

23. Infection control committee
Integral component of the patient safety program of the
health care facility, and is responsible for establishing and
maintaining infection prevention and control, its
monitoring, surveillance, reporting, research and
education.

24. Infection control committee
structure
1. Chairperson: Head of the Institute (preferably)
2. Member Secretary: Senior Microbiologist
3. Members: Representation from Management /Administration
(Dean/Director of Hospital, Nursing Services, Medical Services,
Operations)
4. Relevant Medical Faculties
5. Support Services: (OT/CSSD, Housekeeping / Sanitation,
Engineering, Pharmacologist, Store Officer / Materials
Department)
6. Infection Control Nurse
7. Infection Control officer

25. Aim of sterilization: Asepsis
○Asepsis is the practice to reduce or eliminate
contaminants (such as bacteria, viruses, fungi and
parasites) from entering the operative field in surgery or
medicine to prevent infection.

26. Methods in sterilization
Physical Methods
○Moist heat in Autoclave
○Dry heat in ovens
○Gamma irradiation
○Filtration
○Plasma sterilization
Chemical Methods
○Ethylene oxide
○Glutaraldehyde (high
concentration)

27. Methods in disinfection
Physical Methods
○Boiling &
Pasteurization
○UV radiation
Chemical Agents
○Alcohols
○Aldehydes
○Halogens
○Phenols
○Surfactants
○Heavy metals
○Dyes
○Oxidants

28. Hot air oven
○apparatus with double metallic
walls and a door. There is an air
space between these walls.
○The apparatus is heated by
electricity or gas at the bottom.
○On heating, the air at the bottom
becomes hot and passes between
the two walls from below upwards,
and then passes in the inner
chamber through the holes on Me
top of the apparatus. A thermostat
is fitted to maintain a constant
temperature of 160°C.

29. Hot air oven ○It Is one of the most common
method used for sterilization.
○Glass wares, swab sticks, all-
glass syringes, powder and oily
substances are sterilized in hot air
oven.
○For sterilization, a temperature of
160°C is maintained (holding) for
one hour.
○Spores are killed at this
temperature

30. Autoclave
○Moist heat destroys
microorganisms by the irreversible
denaturation of enzymes &
structural proteins.
○Recommendations for
sterilization in an autoclave are 15
minutes at 121⁰C.

31. Working of autoclave
On the lid, there are:
1. A gauge for indicating the pressure,
2. A safety valve, set to blow off at any desired pressure
3. A stopcock to release the pressure. It is provided with
a perforated diaphragm. Water is placed below the
diaphragm and heated from below by electricity, gas
or stove.

32. Working of autoclave: procedure
1. Place materials inside
2. Close the lid. Leave stopcock open
3. Set the safety valve at the desired pressure
4. Heat the autoclave. Air is forced out and eventually
steam ensures out through the tap
5. Close the tap. The inside pressure now rises until it
reaches the set level (i.e. 15 min), when the safety
valve opens and the excess steam escapes
6. Keep it for 15 minutes (holding time)
7. Stop heating
8. Cool the autoclave below 100°C,
9. Open the stopcock slowly to allow air to enter the
autoclave.

33. Disinfection
○Disinfection is a process where most microbes are
removed from defined object or surface, except spores.
○Classified according to their ability to destroy different
categories of micro-organisms:
1. High Level disinfectants: Glutaraldehyde 2%, Ethylene Oxide
2. Intermediate Level disinfectant: Alcohols, chlorine compounds,
hydrogen peroxide, chlorhexidene
3. Low level disinfectants: Benzalkonium chloride, some soaps

34. General Guidelines for
Disinfection
○Critical instruments/equipment
(that are those penetrating skin or mucous membrane) should
undergo sterilization before and after use.
Ex: surgical instruments.
○Semi-critical instruments / equipment
(that are those in contact with intact mucous membrane without
penetration) should undergo high level disinfection before use and
intermediate level disinfection after use.
Ex: endotracheal tubes
○Non-critical instruments /equipment
(that are those in contact only with intact skin) require only
intermediate or low level disinfection before and after use.
Ex: ECG electrodes

35. Role of physician
Physicians have unique responsibilities for the prevention
and control of hospital infections:
 By providing direct patient care using practices which
minimize infection
 By following appropriate practice of hygiene (e.g.
handwashing, isolation)
 Protecting their own patients from other infected
patients and from hospital staff who may be infected

36. Role of physician
 Complying with the practices approved by the Infection
Control Committee
 Obtaining appropriate microbiological specimens when
an infection is present or suspected
 Notifying cases of hospital-acquired infection to the
team, as well as the admission of infected patients

37. Role of the
hospital pharmacist
The hospital pharmacist is responsible for:
 Obtaining, storing and distributing pharmaceutical
preparations using practices which limit transmission of
infectious agents to patients
 Maintaining records of antibiotics distributed to the
medical departments

38. Role of the
hospital pharmacist
 Providing the Antimicrobial Use Committee and
Infection Control Committee with summary reports and
trends of antimicrobial use.
 Providing summary reports of prevalence of resistance
monitoring sterilization, disinfection and the
environment where necessary
 Participation in development of guidelines for
antiseptics, disinfectants, and products used

39. Role of the nursing staff
Implementation of patient care practices for infection
control is the role of the nursing staff.
The senior nursing administrator is responsible for:
 Participating in the Infection Control Committee
 Promoting the development and improvement of
nursing techniques
 ongoing review of aseptic nursing policies, with
approval by the Infection Control Committee

40. Central sterilization
service
As central sterilization department serves all hospital
areas, including the operating suite, an appropriately
qualified individual must be responsible for
management of the infection control program.
 Oversee the use of different methods - physical,
chemical, and bacteriological - to monitor the
sterilization process
 Ensure technical maintenance of the equipment
according to national standards and manufacturers’
recommendations

41. Role of the
food service
The in-charge of food services must be knowledgeable in
food safety, staff training, storage and preparation
of foodstuffs, job analysis and use of equipment.
The head of catering services is responsible for:
 Defining the criteria for the purchase of foodstuffs
 Equipment use
 Cleaning procedures to maintain a high level of food
safety

42. Role of the
laundry service
The laundry is responsible for:
 Developing policies for working clothes in each area
and group of staff, and maintaining appropriate
supplies
 Ensuring that liquid soap and paper towel dispensers
are replenished regularly

43. Role of the
laundry service
 Distribution of working clothes and, if necessary,
managing changing rooms.
 Developing policies for the collection and transport of
dirty linen.
 Defining, where necessary, the method for disinfecting
infected linen, either before it is taken to the laundry or
in the laundry itself.

44. Role of the
housekeeping service
The housekeeping service is responsible for the regular
and routine cleaning of all surfaces and maintaining a
high level of hygiene in the facility.
 Classifying the different hospital areas by varying need
for cleaning
 Developing policies for appropriate cleaning
techniques: procedure, frequency, agents used, etc.,
for each type of room, from highly contaminated to the
most clean.

45. Role of the
housekeeping service
 Developing policies for collection, transport and
disposal of different types of waste (e.g. containers,
frequency)
 Ensuring that liquid soap and paper towel dispensers
are replenished regularly
 Informing the maintenance service of any building
problems requiring repair.

46. Role of the
infection control team
The infection control program is responsible for:
 Oversight and coordination of all infection control
activities to ensure an effective program.
 Organizing an epidemiological surveillance program for
nosocomial infections
 Participating with pharmacy in developing a program or
supervising the use of anti-infective drugs
 Ensuring patient care practices are appropriate to the
level of patient risk

47. Role of the
infection control team
 Checking the efficacy of the methods of disinfection
and sterilization and the efficacy of systems
 Developed to improve hospital cleanliness participating
in development and provision of teaching program for
the medical, nursing and allied health personnel, as
well as all other categories of staff
 Providing expert advice, analysis, and leadership
assistance for smaller institutions

48. Universal/Standard Precautions
for Infection Control
1. Hand hygiene
2. Personnel protective equipment
3. Safe handling and disposal of sharps
4. Follow needle stick injury protocol
5. Safe handling and disposal of wastes
6. Managing blood and body fluids
7. Disinfection of equipment
8. Environmental disinfection
9. Immunization
10.Isolation

49. Hand hygiene: hand washing technique

51. Personal Protective equipment
Must be used whenever high risk patient is being handled
 Gloves
 Disposable plastic Apron
 Masks.
 Eye protection

52. Safe handling and
disposal of sharps
The main hazards of a sharps injury are:
 Hepatitis B,
 Hepatitis C,
 HIV.
Ensure that:
 Sharps are not passed from hand to hand.
 Needles are not broken or bent before use.
 Sharps are disposed of at the point of use.
 Sharp containers are not filled more than two third.
 Staff are aware of inoculation injury policy.

53. Follow needle stick
injury protocol
1. Irrigate mucous membranes by washing under running
water
2. Do not suck/ Squeeze the injury site
3. Wash with soap and water
4. Apply antiseptic lotion to the injury site.
5. Contact emergency room-medical officer for
management
6. Complete the incident report & inform to ICN

54. Safe handling and disposal of waste
 Segregate the waste at source.
 Know the policies and protocols of the state.
 Safe disposal.
 Safe handling of spillage.

56. Managing blood and bodily fluids
○Handle specimens safely: Collection → Labeling → Transfer
○Dealing with spillage:
 Small spill/ spotted Spill
 Large Spill

57. Managing blood and
bodily fluids
Management of small spill:
 Wear gloves and eye protection
 Contamination should be wiped up with paper towels
soaked in freshly prepared Hypochlorite solution (1%)
 If broken glasses are present, first treat the spillage
with Hypochlorite, then carefully remove the glass
piece with disposable forceps and wipe it up
 Towel and glasses should be disposed off in a yellow
clinical waste bag for Incineration
 Wash hands.

58. Managing blood and
bodily fluids
Management of large spill:
 Mark that area as large spill
 Wear PPE
 Liquid spill should be covered up with Hypochlorite
solution and left for 2 min.
 Use absorbent to absorb
 Wipe that with water and detergent
 Allow that to dry
 Put all the towels, gloves to yellow bin for incineration

59. Infection control checklist
1. Have you washed your hands?
2. Do you need to use personal protective equipment?
3. Are you preventing sharp injuries?
4. Are you disposing off waste safely?
5. Do you deal promptly with spillages?
6. Do you thoroughly decontaminate equipment?
7. Are you maintaining a clean environment?
8. Do you know what to do in the event of an accident?
9. Do you know your workplace's procedures?

60. get
GET INVOLVED
AND
HOSPITAL
ACQUIRED
INFECTIONS