Healthcare-

Associated Infections
(HAIs)

Lesson Plan: HST S2-3 1

 Anticipated Problems

1. What is an infection? What are the most

common HAIs?
2. How do breaks in prescribed protocol lead to
the development of HAIs?
3. What are the signs and symptoms of HAIs?
4. What are protective measures?

2
 Terms
 Affordable Care Act
 catheter
 catheterization
 healthcare-associated infection (HAI)
 hepatitis
 infection
 influenza
 MRSA (methicillin-resistant Staphylococcus
aureus)
3
 Terms

 nosocomial
 pathogen
 prescribed protocol
 present on admission (POA)
 protective measures
 sepsis
 Staphylococcus aureus (staph)
 surveillance

4
 Infection

 An infection is the entry and multiplication of

microorganisms, such as bacteria, viruses, and
parasites, that are not normally present within
the body.

5
 HAI Infection

 A healthcare-associated infection (HAI) is a

disease a patient acquires while receiving
treatment for another condition in a healthcare
setting.
 Sometimes abbreviated HCAI
 Sometimes called a hospital-acquired infection

6
 HAI Infection

 An HAI is nosocomial (of hospital origin)—a

disease that first appears from 48 hours to 4
days after a patient is admitted to a hospital or
other healthcare facility.
 Caused by bacteria, fungi, and
viruses
 Also caused by less common types
of pathogens

7
 HAI Infection

 HAIs are a threat to patient

safety.
 They are a significant cause
of morbidity and mortality.
 About 1 in every 25
inpatients has an infection
related to hospital care at
any given time.

8
 Surveillance

 Surveillance is the monitoring of

behavior, activities, and changing
information related to HAI
investigations, laboratory research,
and prevention.

9
 Surveillance

 Surveillance is lead nationally by the Centers for

Disease Control and Prevention (CDC).
 The CDC uses knowledge gained to detect
infections and to develop new strategies for
preventing them.

10
Diseases & Organisms
In Healthcare Settings
 Acinetobacter
 Burkholderia cepacia
 Clostridium difficile
 Carbapenem-resistant Enterobacteriaceae (CRE)
 Klebsiella
 Mycobacterium abscessus
 Vancomycin-intermediate Staphylococcus aureus

11
Diseases & Organisms
In Healthcare Settings
 Clostridium sordellii – sometimes can result in
 Sepsis is a systemic illness caused by microbial
invasion of normally sterile parts of the body;
sometimes referred to as blood poisoning.

12
Diseases & Organisms
In Healthcare Settings
 Hepatitis is an inflammation of the liver or a
group of viral infections that affect the liver.
 Common types of hepatitis are A, B, and C.
 Outbreaks usually occur in outpatient settings,
hemodialysis units, long-term care facilities, and
hospitals.

13
Diseases & Organisms
In Healthcare Settings
 Influenza is a contagious respiratory illness
caused by influenza viruses.
 Primarily a community-
based infection transmitted
in households and
community settings.

14
Diseases & Organisms
In Healthcare Settings
 MRSA (methicillin-resistant
Staphylococcus aureus) is a potentially
dangerous type of staph bacterium that is
resistant to certain antibiotics and may cause
skin and other infections.
 In the community, most MRSA infections are skin
infections.
 In healthcare settings more severe or potentially
life-threatening MRSA infections occur.

15
Diseases & Organisms
In Healthcare Settings

16
Diseases & Organisms
In Healthcare Settings
 Staphylococcus aureus (staph) is a
bacterium commonly found on the skin and in
the nose of about 30 percent of individuals.
 Most of the time, staph causes no harm.
 Staph infections can look like pimples, boils, or
other skin conditions, and most can be treated.
 In healthcare settings, these infections can be
serious or fatal.

17
Breaks in Prescribed Protocol

 A prescribed protocol is a strict, standardized

guideline used by healthcare workers when
caring for patients.
 About 36% of healthcare-associated infections
are preventable by adherence to prescribed
protocols (Source: CDC reports).

18
Breaks in Prescribed Protocol

 Every hospitalized patient is at

risk for acquiring an infection
from his or her treatment or
surgery.
 Some patients are at greater
risk than others, especially
young children, the elderly,
and persons with compromised
immune systems.

19
Breaks in Prescribed Protocol

 Healthcare-associated
infections are usually related to
procedures used to diagnose or
treat patients’ initial illnesses or
injuries.
 These infections are
associated with a variety of
risk factors.

20
Breaks in Prescribed Protocol

 Indwelling medical devices—These include

bloodstream, endotracheal, and urinary
catheters.
 A catheter is a tubular, flexible instrument
passed through a body channel for withdrawal of
fluids from, or introduction of fluids into, a body
cavity.
 The instrument most commonly associated with HAIs

21
22
Breaks in Prescribed Protocol

 Catheterization—Catheterization is the
passage of a catheter into a body channel or
cavity.
 Adherence to appropriate catheterization
protocols has been suboptimal, with studies
demonstrating that guidelines for wearing
gloves, using appropriate hand hygiene, and
maintaining a sterile barrier have not been
followed.

23
Breaks in Prescribed Protocol

 Surgery—Surgical procedures also place a large

population at risk for surgical site infections by
giving bacteria a route into normally sterile
areas of the body.
 Postoperative
 Contaminated instruments and hands
 Contaminated dressings and hands

24
 Contamination

 A pathogen is an organism that can cause a

disease. Pathogens responsible for HAIs are
found widely in the hospital environment, and
cleaning does not completely eliminate
microorganisms from environmental surfaces.
 Inadequate decontamination has frequently
been associated with outbreaks of infections in
hospitals.

25
 Contamination

 Other sources of contamination in the

healthcare environment:
 Reusable devises
 Single-use devices
 Non-invasive sources
 Transmission between workers and patients
 Overuse and misuse of antibiotics

26
 Contamination

 Devices must never be reprocessed or reused.

Such devices include:
 Nebulizers
 Disposable pulse oximeter probes
 Certain specified intermittent catheters

27
Signs & Symptoms

 To reduce the likelihood

of HAIs, Medicare is now
penalizing hospitals for
what are considered
preventable and costly
illnesses.

28
 Signs & Symptoms

 The Affordable Care Act (a federal statute

signed into law in March 2010 as a part of the
healthcare reform agenda of the Obama
administration) addresses payments for
hospital-acquired infections.

29
 Signs & Symptoms

 For payment, a hospital is required by law to

track information on what is called present on
admission (POA) (an infection present at the
time the order for inpatient admission occurs; a
condition that develops during an outpatient
encounter, including emergency department,
observation, or outpatient surgery).

30
 Signs & Symptoms
 Hospitals exempt from the Present on Admission
(POA) provision are:
 Critical access hospitals
 Long-term-care hospitals
 Waiver hospitals*
 Cancer hospitals
 Children’s inpatient facilities
 Religious non-medical healthcare institutions
 Inpatient psychiatric hospitals
 Inpatient rehabilitation facilities
 Veterans Admin / Department of Defense hospitals
31
 Signs & Symptoms of HAIs

 Fever  Vomiting
 Increased pulse and  Diarrhea
respiratory rates  Rash
 Pain or tenderness  Sores on mucous
 Fatigue and loss of membranes
energy  Redness and swelling
 Loss of appetite of a body part
 Nausea  Discharge or drainage
from the infected area
32
 Signs & Symptoms

 Protective measures are those practices of

infection control and monitoring that deal with
HAIs.
 An infection control program should be adopted,
such as the one sponsored by the U.S. Centers
for Disease Control and Prevention (CDC).

33
 Protective Measures

1. Employ an infection control practitioner for

every 200 beds.
2. Identify high-risk procedures and other
possible sources of infection.
3. Insist on strict adherence to hand-washing
rules by healthcare workers and visitors.

34
Hand Washing

35
 Protective Measures

4. Insist on strict attention to aseptic (sterile)

techniques in the performance of procedures.
5. Sterilize all reusable equipment.
6. Frequently change dressings for wounds and
use antibacterial ointments under dressings.
7. Remove nasogastric (nose to stomach) and
endotracheal (mouth to stomach) tubes as
soon as possible.

36
 Protective Measures

8. Use an antibacterial-coated venous catheter

that destroys bacteria before they can get
into the bloodstream.
9. Prevent contact between respiratory
secretions and healthcare providers by using
barriers and masks as needed.

37
 Protective Measures

10. Limit the use and duration of high-risk

procedures, such as urinary catheterization.
11. Isolate patients with known infections.
12. Sterilize medical instruments and equipment
to prevent contamination.
13. Decrease the general use of antibiotics.
14. Make provisions for training and retraining
the healthcare staff.
38
 Review

1. How quickly does an HAI appear after a patient

is admitted to a hospital or healthcare facility?
2. What is a prescribed protocol?
3. What are the general signs and symptoms of
an HAI?
4. List seven of the fourteen protective measures
a healthcare facility should follow.

39