Dr.

Nadia Aziz
C.A.B.C.M
Baghdad medical college
 Noso ( Latin ) : Clinician

Healthcare-Associated Infection (HAI)

Nosocomial infections are acquired by

5-10% of hospitalized patients.

Nosocomial Infections
Nosocomial Infections
Healthcare-Associated Infection (HAI) Types

HAI

Surgical
Pneumonia Urinary tract Bloodstream Site Others
infection infection Infection

Ventilator- Catheter- Central line-

associated associated associated
(VAP) (CAUTI) (CLABSI)

g
 Surveillance
Infection control program closely monitors the following:
 Patients at high risk of infection.
 Patients with already acquired infections.
 Personnel/patients exposed to communicable diseases,
contaminated equipment, or hazardous reagents.
 Patients in certain areas of the hospital or in certain
rooms.
 Patients in ambulatory settings: home or long-term care
facilities.
 Surveillance
Surveillance is also involved in classifying infections
according to prevalence rates and monitoring
employee health including screening for diseases
and offering immunizations
Screening for diseases prior to employment
 Measles
 Mumps
 Tuberculosis
 Hepatitis
 Diarrheal disease
 Syphilis
 Skin diseases
 Active Surveillance Cultures
 Potential considerations:

 Focus on patients admitted to certain high-risk settings

e.g. ICU

 Generally done at admission but can also be done

periodically during admission

 Patients identified as positive on these surveillance

cultures should be treated

 Applicable to both acute and long-term care settings.

 Common sources of infection
 People
 Contaminated needles or sharps
 IV catheters, Foley catheters, cardiac catheters
 Bronchoscope, respiratory therapy equipment
 Contaminated clothing
 Medical instruments used for surgery or diagnostic
procedures that are reusable
 Some equipment such as tourniquets have low risk of
causing infection.
 Mode of Transmission
 Infections can be transmitted by direct contact, air, medical
instruments, other objects or vectors.

 Airborne infections may be transmitted by coughing, sneezing,

shaking linen, sweeping or inadequate ventilation and can be
prevented by using a mask.

 Inanimate objects (fomites) such as toys, toilets, sinks, linens and

water fountains may provide a means of transmission if
contaminated.

 Mosquitos, ticks, fleas and mites may transmit infections.

 Susceptible Host
 Factors that affect host susceptibility are: age,
drugs, degree and nature of illness, and status
of the host’s immune system.

 Underlying diseases may change status of

host and increase chance of infection.

 Treatment of diseases may lower patient’s

resistance to infections.
Breaking the Chain
 Breaking the Chain
 Must break the chain of infection by strict
adherence to policies involving :
 Hand washing
 Proper waste disposal
 Appropriate laundry service and
housekeeping
 Control of insects and rodents
 Use of disposable equipment and supplies
 Isolation techniques
 Standard Precautions
 Use appropriate barrier protection to prevent skin and mucous
membrane exposure when contact with blood or body fluids is
anticipated.
 Wash hands and contaminated surfaces/equipment
immediately if contaminated with blood or body fluids and
after removing gloves.
 Take the necessary precautions to prevent injuries caused by
handling/disposing of needles, scalpels and other sharp
instruments.
 Standard Precautions
 Use of special equipment to protect from saliva
exposure during resuscitation.

 Appropriate protection when exudative lesions or

dermatitis is present.

 Pregnant health care workers must strictly adhere to

infection control policies.

 Immunization of employees is required for infectious

agents (measles, mumps, rubella) transmitted by air.
 CDC Hand Hygiene Technique
 Alcohol-Based Hand Rubs
 Apply to palm of one hand, rub hands together
covering all surfaces until dry
 Hand washing
 Wet hands with water, apply soap, rub hands together
for at least 15 seconds
 Rinse and dry with disposable towel
 Use towel to turn off faucet
WHO Recommended Hand Hygiene
Technique
Missed Spots When Hand Washing

Between the fingers

Around the fingernails
Back of the thumb
 PREOPERATIVE PREVENION
Environmental Factors
1. Ultraviolet Light
2. Laminar flow ventilation systems
3. Limit operation theater traffic
4. Pre-operative preparations
5. Avoid antibiotic use except for surgical
antibiotic prophylaxis
PREOPERATIVE PREVENTION
6. Eliminate basal colonization with S.aureus
7. Pre-operative antimicrobial shower
8. Treat distant site infections before elective
procedures
9. Hair removal Avoid shaving / hair clipping is
recommended as near to the site of surgery
as possible
10. Skin preparation Scrubbing for 5 to 7
minutes
PREOPERATIVE PREVENTION
11. Resolve malnutrition and obesity
12. Discontinue cigarette smoking
13. Optimize diabetic control
14. Vigilance for breaks in aseptic techniques
PREOPERATIVE PREVENTION
15. LESS DURATION OF SURGERY
16. APPROPRIATE USE OF SURGICAL DRAINS
17. ASEPTIC DRESSINGS
18. FEEDBACK OF SURGEON SPECIFIC INFECTION
RATES TO OTHER SURGEONS TO ADOPT THE SAME
TECHNIQUES AND TO REDUCE SWI
 IDEAL REQUIREMENTS FOR
PREVENTION
1. More space per bed
2. Hand wash area in the wards
3. Special anti-bacterial methods of flooring
4. Air curtains
5. Isolation wards
6. Hand wash area outside each bed in the ICU
 IDEAL REQUIREMENTS FOR
PREVENTION
Airborne infection isolation (AII) refers to the isolation of
patients infected with organisms spread via airborne
droplet nuclei <5 µm in diameter. This isolation area
receives numerous air changes per hour (ACH) and is
under negative pressure, such that the direction of the air
flow is from the outside adjacent space (e.g., the corridor)
into the room.
 RISK REDUCTION OF
PNEUMONIAS
 Hand washing during patient care and after glove removal
 Change gloves after coming into contact with respiratory
secretions, in between patients
 Change tubing, masks and suction catheters between
patients
 Anti-stress ulcer prophylaxis with sucralfate
 Early enteral feeding
 Elevate head of patient to a 30 to 45 degree angle
Prevention of atelectasis
 No routine antimicrobial prophylaxis
Infection control procedures in a
nursery unit
 Infants immune system not developed and
they have increased susceptibility to
infection.
 May pick up pathogens from mom, other
babies or hospital personnel.
 Hand washing procedure much stricter and
must be adhered to.
 Gloves must be worn.
Infection control procedures in a
nursery unit
 Nursery usually provides gowns to be worn
while in the nursery.
 To decrease exposure each baby is assigned to
one nurse.
 Special case is infant whose mom has genital
herpes.
 Baby and mother are isolated.
 Must use gown and gloves.
 Remove contaminated articles by double
bagging.
Infection Control in a Burn Unit
 Patient is highly susceptible to infection.
 Infection rate dramatically decreases if patient is in a
completely closed environment.
 Bed surrounded by plastic curtain with sleeves, use
sleeves to care for patient.
 Everything kept outside of curtain.
 If facility lacks the curtain, house patient in special
room.
 Must use gown, gloves, double bagging of soiled articles
and strict adherence to hand washing technique.
 Sterilize/disinfect room frequently.
Infection Control in a Dialysis Unit
 Patients often immunosuppressed, increasing the risk of
acquiring an infection, especially hepatitis.

 Gown and gloves worn on unit.

 Strict adherence to hand washing technique and glove

use.
 Immunization
For healthcare professionals and patients with end stage
renal disease (ESRD) in the dialysis setting should increase
the rate of immunizations for:

Hepatitis B

Influenza

Pneumococcal
 Infection Control in the Clinical
Laboratory
 Performed primarily by microbiology personnel.
 Maintains lab records for surveillance purposes.
 Reports infectious agents, drug resistant
microorganisms and outbreaks.
 Evaluates effectiveness of sterilization or
decontamination procedures.
 Infection Control in the Clinical
Laboratory
 Prohibiting eating, drinking, mouth pipetting or
smoking in the lab.
 Proper hand washing at the appropriate times.
 Use of appropriate barrier protection such as gloves,
protective clothing, and eye protection.
 Decontamination of work surfaces periodically during
the day and prior to leaving.
 Proper disposal of sharps, including broken glass.
 Proper handling of equipment.
 Infection Control in the Clinical
Laboratory
Application of cosmetics is prohibited in the laboratory
work area.
Hair should be worn or secured so that it cannot become
either a safety hazard or a source of contamination.
Personnel must have annual TB screening.
Personnel are encouraged to receive the Hepatitis B
vaccine
 Site Preparation
 Use sterile supplies for skin and venipuncture.

 Rubbing alcohol (70% isopropyl) for routine

destruction of organisms on the site.

 Blood cultures has more complex site

preparation, requires sterile site.
 Disinfectants and Antiseptics
 Disinfectant
 is a chemical compound used for remove or kill
pathogenic organisms.
 is used on surfaces and instruments, but are too caustic
for direct use on human skin.
 Antiseptics
 are chemicals used to inhibit the growth and
development of microorganisms, but not necessarily kill
them.
 may be used on human skin.
 Intermediate level disinfectants which are HIV-cidal or TB-
cidal should be used to cleanse tourniquets and other
contaminated articles.
Thank you
&
Good Luck