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Hospital acquired infections

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.

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Hospital acquired infections

  1. 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. 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
  3. 3. 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.
  4. 4. 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.
  5. 5. HAI RESULTS IN: ↑ Hospital stay ↑ Long-term disability ↑ Resistance of to anti- microbials ↑ Costs ↑ Mortality
  6. 6. 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
  7. 7. 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
  8. 8. -‫تم‬‫إنشاء‬‫اإلدارة‬‫العامة‬‫لمكافحة‬‫العدوي‬‫التابعة‬‫لقطاع‬‫الطب‬‫الوق‬‫ائي‬ ‫بالوزارة‬‫التابع‬‫ويتبعها‬‫إدارات‬‫مكافحة‬‫العدوي‬‫بمديريات‬‫الشئ‬‫ون‬‫الصحية‬ ،‫بالمحافظات‬‫وتشكيل‬‫فرق‬‫مكافحة‬‫العدوي‬‫بالمستشفيات‬‫ومر‬‫اكز‬ ‫الرعاية‬‫واإلدارات‬‫الصحية‬‫لإلشراف‬‫علي‬‫تنفيذ‬‫برنامج‬‫مكافحة‬‫ا‬‫لعدوي‬. ‫وتم‬‫إصدار‬‫الدليل‬‫القومي‬‫واألدلة‬‫اإلرشادية‬‫والملصقات‬‫والمطبوعا‬‫ت‬ ‫الخاصة‬‫بمكافحة‬‫العدوي‬،‫وتدريب‬‫إدارات‬‫وفرق‬‫ومسئولي‬‫مكافحة‬ ‫العدوي‬‫بالمديريات‬‫الصحية‬،‫والمستشفيات‬‫وتدريب‬‫كافة‬‫مقدم‬‫ي‬‫الخدمة‬ ‫الطبية‬‫علي‬‫معايير‬‫مكافحة‬‫العدوي‬‫العامة‬‫مع‬‫التركيز‬‫علي‬‫األقس‬‫ام‬‫ذات‬ ‫الطبيعة‬‫الخاصة‬. ‫وانشأ‬‫القطاع‬‫منظومة‬‫لترصد‬‫عدوي‬‫المستشفيات‬ً‫وفقا‬‫للمعايي‬‫ر‬‫العالمية‬ ‫ووضعت‬‫معايير‬‫وقائية‬‫للحد‬‫منها‬‫لضمان‬‫تقديم‬‫خدمة‬‫طبية‬‫آمنة‬‫ل‬‫لمواطن‬ ‫المصري‬‫ومنع‬‫انتشار‬،‫الميكروبات‬‫ومنظومة‬‫اخري‬‫لترشيد‬‫استه‬‫الك‬ ‫المضادات‬‫الحيوية‬‫وتم‬‫اعتماد‬‫خطة‬‫قومية‬‫لمجابهة‬‫الميكروبات‬‫المق‬‫اومة‬ ‫للمضادات‬.
  9. 9. 1 LE Infection Control 150-200 LE HAI In Egypt Saves
  10. 10. RESERVOIRS OF INFECTION Patient [ cross- infection or endogenous infection] Health care providers Visitors Objects or substance recently contaminated (environ- mental transfer) Insects & vectors
  11. 11. 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
  12. 12. PORTAL OF EXIT: Respiratory Gastrointestinal Genitourinary Skin & mucous membrane
  13. 13. 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.
  14. 14. COMMON TYPES OF HAIS Urinary tract infections Surgical site infections Blood stream infection (septicemia) Hospital acquired pneumonia
  15. 15. 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.
  16. 16. Hand washing before & after patient contact prevents 80% of infection. It is very simple method of prevention but it is very effective.
  17. 17. 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.
  18. 18. TERTIARY PREVENTION: Rehabilitation Compensation One of the patient's rights is to take safe medical care.

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