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 Definisi HAIs

Nosocomial infection
CDC, 2007

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Healthcare-associated infection
ONLY infections acquired
in HOSPITALS
infections associated with
healthcare delivery in any setting
(e.g., hospitals, long-term care facilities,
ambulatory settings, home care)

• develop during hospitalization but are neither present nor

incubating upon the patient’s admission to the hospital;
generally for those infections that occur more than 48 to 72
hours after admission and within 10 days after hospital
discharge
 HAIs
• affect 5-10% of hospitalized patients in the
U.S. per year --> 99,000 deaths --> $20
billion in healthcare costs
 Infection Triad
3 main factors related to development of HAIs
- Host factors
- Agent factors
- Environmental factors
 Host Factors
• Coma • Advanced age or
premature birth
• HIV infection • severe burns and
• Malignancies certain skin diseases
• Diabetes mellitus • Chronic obstructive
pulmonary disease
• Severe malnutrition • Immunodeficiency (due
• Circulatory impairment to drug, or irradiation)
• Open wound or trauma • Surgery
• Transplantation
• Bronchopulmonary
• Indwelling devices
disease

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 Agent Factors
• An infectious agent can be bacteria, virus,
fungus, or parasite
• The majority of HAIs are caused by bacteria or
viruses
• Two major types of bacteria that cause HAIs
• Gram-positive cocci (e.g., Staphylococci and
Streptococci)
• Gram-negative bacilli (e.g., Acinetobacter,
Pseudomonas, Klebsiella)
 Environment Factors
• Extrinsic factors that affect either the
infectious agent or a person’s risk of
exposure to that agent
• Include both the animate and inanimate
environment of patients

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 Chain of Infection
• Infection results from an interaction between an
infectious agent and susceptible host
• The interaction occurs by means of contact between
the agent and the host and is affected by the
environment
• Breaking the chain of infection by interrupting
transmission generally the best way to prevent HAIs

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 Reservoir (source of infectious agent)

• Place in which an infectious agent can survive

but may or may not multiply

Equipment
Humans -- primarily
Animals
 Human reservoirs
• active infections
patients • asymptomatic
• incubation period of an
healthcare infectious disease
personnel • transiently or chronically
colonized with pathogenic
household microorganisms -->
members respiratory and
gastrointestinal tracts.
visitors
 Portal of Exit
The path by which an
infectious agent
leaves the reservoir
– Respiratory tract
– Genitourinary tract
– Gastrointestinal
tract
– Skin/mucous
membrane
– Blood
– Transplacental

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 Modes of transmission
• A pathogen may be transmitted by a single route
or it can be transmitted in several ways

Modes of
transmission

Contact Droplet Airborne

 Contact transmission
Direct contact
• person-to-person spread, actual physical contact
• Example:
– blood or other blood-containing body fluids from a patient directly enters
a caregiver’s body through contact with a mucous membrane or breaks
(i.e., cuts, abrasions) in the skin
– mites from a scabies-infested patient are transferred to the skin of a
caregiver while he/she is having direct ungloved contact with the
patient’s skin
Indirect contact
• contact with contaminated intermediate object
• Example
– contaminated hands of healthcare personnel
– Patient-care devices
– Shared toys among pediatric patients
– Clothing, uniforms, laboratory coats, or isolation gowns
 Droplet transmission
• Large droplets generated by an infected or colonised person
during coughing, sneezing, talking, suctioning, endotracheal
intubation.
• Droplets propelled a short distance <3m
• Droplets deposited on a susceptible host’s eyes, nasal mucosa or
mouth
• Examples of infectious agents
– Bordetella pertussis
– influenza virus
– adenovirus
– rhinovirus
– Mycoplasma pneumoniae
– SARS-associated coronavirus (SARS-CoV)
– group A streptococcus
– Neisseria meningitidis
 Airborne transmisson
• airborne droplet nuclei or small particles in the respirable
size range containing infectious agents that remain
infective over time and distance
• transmitted to a susceptible host by air currents (not
face-to-face contact)
• Example:
– Aspergillus spp spore
– Mycobacterium tuberculosis
Common Vehicle Transmission
Microorganisms are transmitted
to susceptible hosts from
common items:
– Food
– Water
– Medications
– Devices/equipment

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 Portal of Entry
The path by which an infectious agent
enters the susceptible host
» Respiratory tract
» GU tract
» GI tract
» Skin/mucous membrane
» Parenteral
» Transplacental

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Susceptible Host
A person lacking
effective resistance to a
particular microorganism

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Terima kasih