11/24/2020

HOSPITAL ACQUIRED
INFECTION
& its prevention

Objectives

To identify :
○ Hospital acquired infections
○ Sources of infection
○ Routes of spread
○ Antimicrobial resistance
○ Hospital Infection Prevention and Control Guidelines
○ Universal and standard precautions

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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.

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

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Magnitude of the problem

HAI occur worldwide and affect both developed
HAI - burden
and resource-poor countries.

Over 1.4 million people worldwide suffer from such

infectious

○Most frequent of these are:

 Surgical wounds infections
 Urinary tract infections
 Lower respiratory tract infections

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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

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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

Common infections in ICU

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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.

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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.

Type

Ability, virulence

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Risk factors of
occurrence of
nosocomial
infection

Sources of infection in the hospital

Air Water /
Surgical
procedures food

Hospital
Pt’s
persons
normal
flora

Visitors Fomite
contamination

Devices,
Other drains
patients and
catheter

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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)

Sources of infection in the hospital

Endogenous sources

○ Source is the normal intestinal flora or colonizers of skin

and other epithelial surfaces

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Examples of
source of the
nosocomial
infection in
hospital
1- IV line

Examples of source of
the nosocomial
infection in hospital

2- Catheter

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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

World Antibiotic Awareness Week (12-18 November 2020) aims to

increase global awareness of antibiotic resistance (AMR) and to
encourage best practices among the general public, health workers
and policy makers to avoid the further emergence and spread of
antibiotic resistance.

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Hospital Infection

Hospital Infection
Prevention & Control
Guidelines
Prevention and Control

Guidelines

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Infection control committee

It is the 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.

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
Support Services: (Central Sterile Supply Department , Housekeeping /
Sanitation, Engineering, Pharmacologist, Store Officer / Materials Department)
6. Infection Control Nurse
7. Infection Control officer

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Sterilization
Sterilization: the destruction of all living
microorganisms, as pathogenic or saprophytic
bacteria, vegetative forms, and spores.
describes a process that destroys or eliminates all forms
of microbial life and is carried out in health-care facilities
by physical or chemical methods.
Steam under pressure, dry heat, Ethylene Oxide
gas, hydrogen peroxide gas plasma, and liquid
chemicals are the principal sterilizing agents used
in health-care facilities

Methods in sterilization

Physical Methods Chemical Methods

○Moist heat in Autoclave
○Dry heat in ovens ○Ethylene oxide
○Gamma irradiation ○Glutaraldehyde
○Filtration (high concentration)
○Plasma sterilization

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Methods in disinfection

Physical Methods Chemical Agents

○Boiling & ○Alcohols
Pasteurization ○Aldehydes
○UV radiation ○Halogens
○Phenols
○Surfactants
○Heavy metals
○Dyes
○Oxidants

○Apparatus with double metallic

Hot air oven 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.

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○It Is one of the most common

Hot air oven 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

Autoclave

○Moist heat destroys

microorganisms by the irreversible
denaturation of enzymes &
structural proteins.

○Recommendations for
sterilization in an autoclave are 15
minutes at 121⁰C.

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Disinfection

It describes a process that eliminates many or all

pathogenic microorganisms, except bacterial spores,
on inanimate objects.
In health-care settings, objects usually are disinfected
by liquid chemicals or wet pasteurization.

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

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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

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

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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

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

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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

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

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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

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

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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

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.

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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.

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.

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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

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

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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

Hand hygiene: hand washing technique

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Personal Protective equipment

Must be used whenever high risk patient is being handled

 Gloves
 Disposable plastic Apron
 Masks.
 Eye protection

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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.

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

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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.

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Managing blood and bodily fluids

○Handle specimens safely: Collection → Labeling → Transfer

○Dealing with spillage:

 Small spill/ spotted Spill
 Large Spill

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.

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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

Infection control checklist

n 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?

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Infection control in dentistry

◌ ◌ 

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◌ ◌ 

  

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◌ ◌ 

◌ ◌ 

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GET INVOLVED
AND

HOSPITAL
ACQUIRED
INFECTIONS

34
 Biosafety levels

Prof. Nahla K. Ibrahim

1

Biosafety levels

& Small
pox

Prof. Nahla K. Ibrahim

2

1
 Biosafety levels

H1N1,
SARS-CoV1 & Small
MERS, pox
SARS-CoV-2

Prof. Nahla K. Ibrahim

3

Prof. Nahla K. Ibrahim

4