Hospital Infection Control Programme

1
HOSPITAL INFECTION CONTROL CURRENT PERCEPTIONS

• Dr.T.V.Rao MD

2
A Tribute to
Ignaz Semmelweiss (1818-1865)

• Ignaz Semmelweiss (1818-1865)
• Obstetrician, practised in Vienna
• Studied puerperal (childbed) fever
• Established that high maternal mortality was due
  to failure of doctors to wash hands after
  post-mortems
• Reduced maternal mortality by 90
• Ignored and ridiculed by colleagues

3
What is Hospital Acquired Infections

• Any infection that is not present or incubating
  at the time the patient is admitted to the
  hospital

4

Consequences of Hospital Acquired Infections

• Additional morbidity
• Prolonged hospitalization
• Long-term physical, developmental and
  neurological sequelae
• Increased cost of hospitalization
• Death

5
Why Everyone Concerned with Hospital Infections

• The Centers for Disease Control (CDC) estimates
  that 2 million U.S. patients a year acquire
  hospital-related infections. These infections
  cost an average of 47,000 per patient to treat
  and cause 90,000 deaths each year. The added cost
  to hospitals is 4.8 billion annually in extended
  care and treatment.

6
What is Infection Control

• Infection control is the discipline concerned
  with preventing nosocomial or healthcare-associate
  d infection. As such, it is a practical (rather
  than an academic) sub-discipline of epidemiology.
  It is an essential (though often under-recognized
  and under-supported) part of the infrastructure
  of health care. Infection control and hospital
  epidemiology are akin to public health practice,
  practiced within the confines of a particular
  health-care delivery system rather than directed
  at society as a whole.

7
Infection Control is Complex programme

• Infection control addresses factors related to
  the spread of infections within the health-care
  setting (whether patient-to-patient, from
  patients to staff and from staff to patients, or
  among-staff), including prevention (via hand
  hygiene/hand washing, cleaning/disinfection/steril
  ization, vaccination, surveillance),
  monitoring/investigation of demonstrated or
  suspected spread of infection within a particular
  health-care setting (surveillance and outbreak
  investigation), and management (interruption of
  outbreaks).

8
Beginning of Hospital Infection Programme

• Modern hospital infection control programs first
  began in the 1950s in England, where the primary
  focus of these programs was to prevent and
  control hospital-acquired staphylococcal
  outbreaks. In 1968, the American Hospital
  Association published "Infection Control in the
  Hospital," the first and only standards available
  for many years.

9
Centre For Disease Control and Prevention

• The Communicable Disease Center, later to be
  renamed the Centers for Disease Control and
  Prevention (CDC), began the first training
  courses specifically about infection control and
  surveillance.

10
CDC Initiates Hospital Infection Branch

• In 1972, the Hospital Infections Branch at the
  CDC was formed and the Association for
  Practitioners in Infection Control was organized.
  By the close of the decade, the first CDC
  guidelines were written to answer frequently
  asked questions and establish consistent
  practice.

11
First Data on Infection Control Efficacy

• In 1985, the Study of the Efficacy of Nosocomial
  Infection Control (SENIC) project was published,
  validating the cost-benefit of infection control
  programs. Data collected in 1970 and 1976-1977
  suggested that one-third of all nosocomial
  infections could be prevented

12
Joint Commission on Accreditation of Healthcare
Organizations (JCAHO)

• In 1969, the Joint Commission for Accreditation
  of Hospitals--later to become the Joint
  Commission on Accreditation of Healthcare
  Organizations (JCAHO)--first required hospitals
  to have organized infection control committees
  and isolation facilities

13
CDC formulates Guidelines on Infection Control

• In 1972, the Hospital Infections Branch at the
  CDC was formed and the Association for
  Practitioners in Infection Control was organized.
  By the close of the decade, the first CDC
  guidelines were written to answer frequently
  asked questions and establish consistent
  practice.

14
Break the Chain of Infections

• 1. Organisms that can cause infection are subject
  to risk assessment under the COSHH regulations
  and Management of Health and Safety at Work
  Regulation 1992.

15
Risk assessment of Substances in use for ICP

• Various substances such as disinfectants used to
  prevent cross infection are subject to risk
  assessment prior to use. Health and Safety
  guidance highlights the importance of the risk
  assessment process i.e. Identify the risk
• Assess the risk
• Note current measures which are being used to
  control or mitigate the risk
• Inform/train staff
• Monitor outcomes
• Implement policies and procedures

16
Beginning of AIDS Pandemic Necceciates Stronger
Infection Control Protocols

• The second and certainly most significant factor
  influencing infection control at the time was the
  advent of acquired immunodeficiency syndrome
  (AIDS). The human immunodeficiency virus (HIV)
  has taken an enormous toll in terms of loss of
  life and productivity. For infection control
  professionals (ICPs), HIV has been a challenge
  for education, risk reduction and resource
  utilization.

17
Study of the Efficacy of Nosocomial Infection
Control (SENIC) project

• Study of the Efficacy of Nosocomial Infection
  Control (SENIC) project was published, validating
  the cost-benefit of infection control programs.
  Data collected in 1970 and 1976-1977 suggested
  that one-third of all nosocomial infections could
  be prevented if all the following were present
• One infection control professional (ICP) for
  every 250 beds.
• An effective infection control physician.
• A program reporting infection rates back to the
  surgeon and those clinically involved with the
  infection.
• An organized hospital-wide surveillance system.

18
Infection Control Challenges of Healthcare in
2000

• Decreasing reimbursement
• Increasing emerging infections
• Increasing resistant organisms
• Increasing drug costs
• Institute of Medicine Report--healthcare-associate
  d infections
• Nursing shortage
• OSHA safety legislation
• Multiple benchmark systems
• FDA legislation on reuse of single-use devices

19
Infection control was influenced by the reform of
the Healthcare System

• Infection control programs had to encompass not
  only hospitals but also the long-term care
  facility, home health/hospice, rehabilitation
  facilities, free-standing surgical centers, and
  physician office practices. A dramatic shift in
  patient care practices occurred as greater than
  65 of surgery cases were operated on in an
  outpatient setting. Issues that will continue to
  impact infection control programs into the new
  millennium are a challenging combination of cost
  and clinical factors and increasing cost to
  treat infections, and financial impact of
  implementing new government regulations .

20
Changing Demands on Infection Control programme

• Today's ICP needs knowledge of epidemiology
  statistics, patient care practices, occupational
  health, sterilization, disinfection, and
  sanitation, infectious diseases, microbiology,
  education and management

21
Infection Control Committee and Antibiotic
Policies are Back bone for reduction of Infections
22
Major Responsibilities of I C P

• The major responsibilities for ICPs to oversee
  include surveillance, specific environmental
  monitoring, continuous quality improvement,
  consultation, committee involvement, outbreak and
  isolation management, regulatory compliance and
  education. To plan, coordinate, and succeed in
  fulfilling these responsibilities, many ICPs have
  to redefine their roles. More ICPs are becoming
  managers by creating multidisciplinary support
  teams to carry out many of the functions.

23
GUIDELINES AND RECOMMENDATIONS

• Hand washing and Hospital Environmental Control
  Immunization Infectious Diseases Control
  Intravascular Device-Related Infections and its
  control Isolation Precautions

24
Good House Keeping a Boon to Infection Control
25
Scientific Disinfection Practices Saves Several
Lives

• Long-Term Care Facilities Guidelines for
  Infection Control in Health Care Personnel
  Surgical Site Infections Control Urinary Tract
  and Respiratory Tract Infections Control
  Ordering and Preparing Guidelines appropriately
• Home care
• Hospital Construction
• Sterilization / Disinfection

26
Surveillance

• The key to ongoing monitoring is surveillance for
  nosocomial infections. Various techniques for
  surveillance have been described and evaluated
  including total house surveillance, targeted
  surveillance, Kardex, or laboratory-base

27
Computerized Surveillance

• Surveillance traditionally involved significant
  manual data assessment Increasingly, integrated
  computerized software solutions are becoming
  available that assess incoming risk messages from
  microbiology and other online sources. By
  reducing the need for data entry, this software
  significantly reduces the data workload of ICPs,
  freeing them to concentrate on clinical
  surveillance.

28
Infection Control programme is Hospital Oriented

• ICPs should evaluate their institutional needs
  and develop a surveillance plan to present to the
  infection control committee on a yearly basis.
  Choosing one or two specific surveillance
  problems and setting a goal for reduction will
  focus the efforts of the ICP. JCAHO requires
  documenting the rationale for selecting a
  specific surveillance approach

29
Outbreak Investigations

• Unlike scheduled activities, occasional clusters
  of patients who are colonized or infected will
  trigger further investigation including a
  case-control study. New laboratory methods
  developed and refined within the last decade can
  now determine how related the strain is at the
  molecular level.

30
Infection Control Programme Integrated with
Health Authorities

• The institution usually makes the infection
  control program responsible for reporting
  communicable diseases required by state law. ICPs
  need to plan on interacting with local and state
  health departments regarding exposure that may
  need immediate community follow-up (e.g.,
  tuberculosis, Cholera). ICPs should assist the
  health department in confirming cases that may
  have been seen in the hospital or clinic.

31
Formulating an Infection Control Plan

• Every infection control program should develop a
  well-defined written plan outlining the
  organizational philosophy regarding infection
  prevention and control. The plan should take into
  account the goals, mission statement, and an
  assessment of the infection control program. It
  should include a statement of authority, and
  should review patient demographics including
  geographic locations of patients served by the
  healthcare system

32
Staff Training in ICP

• Education programs for employees and volunteers
  are one method to ensure competent infection
  control practices. It is a unique challenge since
  employees represent a wide range of expertise and
  educational background. The ICP must become
  knowledgeable in adult education principles and
  use educational tools and techniques that will
  motivate and sustain behavioral change.

33
Infection Control Programme and Documentation

• Goals of the infection control program need to be
  incorporated into the mission statement of the
  facility. A mission statement should tell who you
  are, what you do, and should communicate a clear
  view of purpose and set a strategy for
  accomplishing the goal

34
Document Antibiograms with WHONET

• WHONET is a free Windows-based database software
  developed for the management and analysis of
  microbiology laboratory data with a special focus
  on the analysis of antimicrobial susceptibility
  test results.

35
CDC Guides the Medical profession ICP

• CDC with the Hospital Infection Control Practices
  Advisory Committee (HICPAC) has produced or
  revised several major guidelines in the past two
  years including, Guidelines for Infection Control
  in Healthcare Personnel, and Guidelines for
  Management of Healthcare Worker Exposures to HIV
  and Recommendations for Post exposure
  Prophylaxis, Guidelines for Prevention of
  Surgical Site Infections. APIC has developed
  several guidelines covering topics including
  antisepsis and hand washing, disinfection and
  sterilization, endoscopy, and long-term care.

36
Health Care Means In patient care and outpatient
care

• Significant trends in healthcare are occurring
  everyday including new medical procedures (i.e.,
  gene therapy), new technology (multi-purpose
  intravenous catheters), and a shift from
  inpatient to outpatient care.

37
NEW TECHNOLOGIES IN HOSPITAL INFECTIONS
38
Light technology to combat Hospital Infections

• A pioneering lighting system that can kill
  hospital superbugs including MRSA and C.diff
  has been developed by researchers at the
  University of Strathclyde in Glasgow, Scotland.
  The technology decontaminates the air and exposed
  surfaces by bathing them in a narrow spectrum of
  visible-light wavelengths, known as HINS-light.

39
Light technology to combat hospital infections

• The technology decontaminates the air and exposed
  surfaces by bathing them in a narrow spectrum of
  visible-light wavelengths, known as HINS-light.
• Clinical trials at Glasgow Royal Infirmary have
  shown that the HINS-light Environmental
  Decontamination System provides significantly
  greater reductions of bacterial pathogens in the
  hospital environment than can be achieved by
  cleaning and disinfection alone, providing a huge
  step forward in hospitals' ability to prevent the
  spread of infection.

40
Light Technology to Combat Hospital Infections

• HINS-light is a safe treatment that can be easily
  automated to provide continuous disinfection of
  wards and other areas of the clinical
  environment. The pervasive nature of light
  permits the treatment of air and all visible
  surfaces, regardless of accessibility, either
  through direct or reflected exposure to
  HINS-light within the treated environment

41
Medical Dressing Uses Nanotechnology to Fight
Infection

• Scientists at the University of Bath and the
  burns team at the Southwest UK Pediatric Burns
  Centre at Frenchay Hospital in Bristol are
  working together with teams across Europe and
  Australia to create an advanced wound dressing.

42
New Bandages Change Color If Infections Arise

• The dressing will work by releasing antibiotics
  from Nano capsules triggered by the presence of
  disease-causing pathogenic bacteria, which will
  target treatment before the infection takes hold.

43
New Nanotechnology for Hospital Infection Control
Receives FDA Approval

• SilvaGard can be used to treat virtually any
  medical device and its use does not alter the
  device's original properties. Due to these and
  other unique attributes, SilvaGard is expected to
  have a significant impact on the battle against
  hospital-related infections.

44
Recent Studies on Infection Control and
Prevention
45
Long Sleeves x Short Sleeves

• Results from a study by Denver Health and
  University of Colorado Health Services Center
  researchers showed there were no statistically
  significant differences found in bacterial or
  MRSA counts between physicians coats and newly
  laundered short-sleeved uniforms.The researchers
  findings sheds new light on British government
  agencies policies banning physicians white
  coats based on the belief that long sleeves carry
  more bacteria and pose a greater risk of
  bacterial transmission

46
. Vision-based hand gesture recognition Technology

• The technology relies on hand gestures as
  commands, which can control robotic nurses or
  tell computers to display pertinent patient
  health information, Juan Pablo Wachs, assistant
  professor of industrial engineering at Purdue
  University works and popularises.The vision-based
  hand gesture recognition technology could also be
  used for the coordination of emergency response
  activities during disasters.

47
Involvement of Physicians More Important

• Physicians to be more involved and lead quality
  improvement efforts in their respective
  healthcare settings. Drs. Pronovost and
  Marsteller suggest that even though quality
  improvement efforts exist, there is not enough
  data supporting the notion that quality
  improvement efforts are actually enhancing
  patient outcomes. One of the reasons for this
  lack of progress, they say, is inadequate
  physician engagement and leadership in quality
  improvement work.
• Peter Pronovost, MD, PhD, and Jill Marsteller,
  PhD, MP

48
Scientific Documentation Reduces Hospital
Infections

• Researchers evaluated the effect of an electronic
  medical record on the use of antimicrobial agents
  and infection rates of Clostridium difficile and
  MRSA. Results showed that implementation of an
  EMR significantly increased chart reviews and
  antimicrobial recommendations, leading to a
  decrease in antimicrobial use and MRSA as well as
  C. difficile infection rates.

49
Impact of Hand Washing on Influenza

• Health experts believe a flu epidemic was averted
  last year because of regular hand-washing,
  suggesting healthcare facilities should promote
  hand-washing among staff and patients to prevent
  the spread of disease. The American Society for
  Microbiology and the American Cleaning Institute
  released a study in Sept. 2010 reporting that 85
  percent of people washed their hands in public
  restrooms in 2008, the highest levels observed
  since the research began in 1996.

50
Hand Hygiene Compliance

• Researchers have implemented a hand hygiene
  program driven by a behavioral change approach to
  increase hand hygiene compliance. The hand
  hygiene program was packaged with several
  initiatives. It included access to alcohol
  sanitizer, education as well as ongoing audit and
  feedback. The program was also supplemented with
  behavior modification practices, such as
  immediate positive reinforcement as well as
  annually changing incentives. The researchers
  report the program has resulted in significant
  and sustained improvements in hand hygiene
  compliance.

51
Which Skin Preparation Agent is Superior

• Researchers conducted a review of surgical skin
  prep agents to conclude which agent was most
  cost-effective and superior in preventing
  surgical site infections. Based on information
  collected from two databases, researchers
  compared povidone-iodine, Chlorhexidine
  gluconate, parachoroxylenol and iodine povacrylex
  (0.7 percent available iodine) in 74 percent
  isopropyl alcohol (DuraPrep). Researchers
  concluded that each prep agent has specific
  advantages and disadvantages and no one skin prep
  agent is superior in all clinical situations.
  Factors to consider when choosing a skin prep
  agent include surgeon preference and
  environmental risks.

52
Health Care Workers are at Risk
Need for Vaccination

• Health care workers may be exposed to certain
  infections in the course of their work. Vaccines
  are available to provide some protection to
  workers in a healthcare setting. Depending on
  regulation, recommendation, the specific work
  function, or personal preference, healthcare
  workers or first responders may receive
  vaccinations for hepatitis B influenza measles,
  mumps and rubella Tetanus, diphtheria,
  pertussis N. meningitides and varicella.
• The problem of resources for proving Vaccines in
  Developing countries continues to be real
  problem, need additional economic resources

53
Become a Member of Alliance for the Prudent Use
of Antibiotics (APUA)
www.apua.org

• An international organization dedicated to
  curbing antibiotic resistance
• Chapters exist currently in several Asian
  countries Australia, China, India, Nepal,
  Pakistan, Philippines, South Korea, Taiwan,
  Vietnam

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• Created by Dr.T.V.Rao MD for e learning
  resources for Infection Control Personal in the
  Developing World
• Email
• doctortvrao_at_gmail.com