HAIs on COVID-19 Pandemic

Agung Dwi Wahyu Widodo

Departemen Mikrobiologi Kedokteran, Fakultas Kedokteran Unair
PAMKI Cabang Surabaya
 Subyek
• HAIs Introduction
• Pandemic COVID-19
• COVID-19 sebagai HAIs
• HAIs pada COVID-19
• MDROs Pada HAIs-COVID-19
• Kesimpulan
Chain of Infection
Healthcare-associated infection (HAI)
• An infection that develops in a patient who is cared for in
any setting where healthcare is delivered (e.g., acute care
hospital, chronic care facility, ambulatory clinic, dialysis
center, surgicenter, home) and is related to receiving health
care (i.e., was not incubating or present at the time
healthcare was provided).
• In ambulatory and home settings, HAI would apply to any
infection that is associated with a medical or surgical
intervention.
• Since the geographic location of infection acquisition is
often uncertain, the preferred term is considered to be
healthcare-associated rather than healthcare-acquired.
Siegel et al, 2007 guideline for isolation precaution,
an updated 2019
 HAIs definition by CDC
• the CDC defines an HAI as
• a localized or systemic condition resulting
from an adverse reaction to the presence of
an infectious agent(s) or its toxin(s).
• There must be no evidence that the infection
was present or incubating at the time of
admission to the acute care setting.

Horan et al, Am J Infect Control 2008;36:309-32.

 HAIs Infectious agents Sources
• HAIs may be caused by infectious agents from
endogenous or exogenous sources.
• Endogenous sources are body sites, such as the
skin, nose, mouth, gastrointestinal (GI) tract, or
vagina that are normally inhabited by
microorganisms.
• Exogenous sources are those external to the
patient, such as patient care personnel, visitors,
patient care equipment, medical devices, or the
health care environmen
Horan et al, Am J Infect Control 2008;36:309-32.
 Infections are not HAI
• The following infections are not considered healthcare
associated:
• Infections associated with complications or
extensions of infections already present on admission,
unless a change in pathogen or symptoms strongly
suggests the acquisition of a new infection;
• Infections in infants that have been acquired
transplacentally (eg, herpes simplex, toxoplasmosis,
rubella, cytomegalovirus, or syphilis) and become
evident #48 hours after birth;
• Reactivation of a latent infection (eg, herpes zoster
[shingles], herpes simplex, syphilis, or tuberculosis)
Horan et al, Am J Infect Control 2008;36:309-32.
 Conditions are not Infection
• The following conditions are not infections:
• Colonization, which means the presence of
microorganisms on skin, on mucous membranes,
in open wounds, or in excretions or secretions
but are not causing adverse clinical signs or
symptoms;
• Inflammation that results from tissue response
to injury or stimulation by noninfectious
agents, such as chemicals.
Horan et al, Am J Infect Control 2008;36:309-32.
Covid-19- HAIs
phylogeny
HAIs by Year
Causative Agent of HAIs
Peningkatan HAIs pada2020 (NHSN)
CLABSI vs CAUTI
Agent of CLABSI vs CAUTI
HAIs and Agents
Distribution of HAIs
Distribution of Pathogens
Prevalensi Pathogens
HAIs MDROs
CDI on COVID-19 (Italy)
Microbiological of Candidemia
Outcome of Candidemia
 Data Kasus Outbreak MDRAB
Kurve Epidemic
14 13
12
12

10 9
Jumlah Kasus

8
Acinetobacter baumanii
6 5 Pseudomonas aeruginosa
4 4
4 3 3 3 3 3
2 2
2 1 1 1 1 1 1 1
0 0
0
April Mei Juni Juli Agst Sept Okt Nov Des Jan Feb

Th. 2020 - 2021

 Aciba Vs Covid-19
• Covid-19- Imunokompromis
• Multiple Invasive Device
• Multiple Drugs
• Multiple antimicrobials
• Immunosupresant as Corticosteroid
• Microbiota Dysbiosis
• Super-Infections Opportunistic bugs
Kasus Aciba 2020
Kasus Aciba 2021
Fenotipe Aciba Sputum R Covid
 Kesimppulan
• Pandemic Covid-19 merupakan Masalah
Global
• Covid-19 dapat menjadi HAIs
• Covid-19 meningkatkan HAIs
• HAIs pada Covid-19 dapat disebabkan oleh
MDROs
Arigatou Gozaimasu