HOSPITAL ASSOCIATED

Infections
overcoming emerging challenge
Dr.T.V.Rao MD

10-03-2016

Dr.T.V.Rao MD

Aim of Infection Prevention

The aim of the Infection
Prevention and Control
Service is to promote as safe
an environment as possible
for staff, patients and
visitors, in order that the risk
of healthcare associated
infections are kept to a
minimum.
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Dr.T.V.Rao MD

What matters Infection to patients and

many around
For most patients and their
families, the process of
healthcare appears to be a
simple one. Patients are
admitted to the facility and a
specific course of treatment
and care is carried out by
physicians, nurses, and
technicians
It is the beginning of many
matters and infection is a
great preventable factor
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Never forget the safety of the Patients is

interdisciplinary factor
Every healthcare facility uses
interdisciplinary task forces such
as the Safety Committee and the
Infection Control Committee to
minimize patient and employee
risk. Although its existence may
not be widely recognized by
patients, the Infection Control
Committee plays an integral part
in the care of every patient.
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Dr.T.V.Rao MD

Objectives of Infection Control

Understand basic infection control (IC) concepts
Understand the causes of nosocomial infections
Understand the components of an infection
control program
Understand how the Infection Control
Committee and DTC can decrease the incidence
of nosocomial infections and antimicrobial
resistance (AMR)

IntroductionWhy Infection Control?

Hospital acquired infections are a common problemprevalence about 9%

Hospital acquired infections contribute to AMR
Overuse of antimicrobials (development)
Poor infection control practices (spread)
Hospital-acquired infections increase the cost of health care
World Bank studies have shown that two-thirds of developing countries
spend more than 50% of their health care budgets on hospitals
Effective IC programs are beneficial
They decrease spread of nosocomial infections, morbidity, mortality, and
health care costs
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Dr.T.V.Rao MD

Why Is the Infection Control Committee

Important?
Everyone knows that
infection control is the
responsibility of all
healthcare workers.
Patients and employees are
only safe from infectious
processes when everyone
follows good infection
control techniques
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Dr.T.V.Rao MD

Why Is the Infection Control Committee

Important?
The purpose of the Infection Control Committee is not
to reduce the individual responsibility that each
healthcare provider has, but to provide leadership for
all employees throughout the facility. Through
policies, procedures, and evaluation processes, the
committee acts as a central clearing house for all
infection control information and channels that
information in a manner that will create the safest
healthcare environment.
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Dr.T.V.Rao MD

Why Is the Infection Control Committee

Important?
It also helps to standardize infection control procedures
throughout the facility so that the same level of care is
provided in all departments. This standardization helps to
control and maintain the facility's environment and ensures
that patients receive the same level of infection control in all
areas. For example, the Infection Control Committee may
take steps to ensure that the standard for instruments used
in invasive procedures performed outside of the OR is the
same as invasive procedures performed .
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What is Infection Control

Infection ControlThe
process by which health
care facilities develop
and implement specific
policies and procedures
to prevent the spread of
infections among health
care staff and patients
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Nosocomial Infection

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Nosocomial
InfectionAn infection
contracted by a
patient or staff
member while in a
hospital or health care
facility (and not
present or incubating
on admission)

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Terms we should be Familiar

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Disinfection
DisinfectionThe
process of microbial
inactivation that
eliminates virtually all
recognized pathogenic
microorganisms, but not
necessarily all microbial
forms (e.g., spores)
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Sterilization
SterilizationThe use of physical
or chemical procedures to
destroy all microbial life,
including large numbers of
highly resistant bacterial
endospores. Procedures
include
Steam sterilization
Heat sterilization
Chemical sterilization
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Root Causes of Nosocomial Infections

Lack of training in basic IC
Lack of an IC infrastructure and
poor IC practices (procedures)
Inadequate facilities and
techniques for hand hygiene
Lack of isolation precautions
and procedures
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Epidemiology of Nosocomial Infections

Most common sites for
nosocomial infections

Surgical incisions
Urinary tract (i.e.,
catheter-related)
Lower respiratory
tract
Bloodstream (i.e.,
catheter-related)

Epidemiology of Nosocomial Infections

Common microorganisms

Aerobic gram-positive
cocci (Staphylococcus
aureas [MRSA],
enterococci [vancomycinresistant]),
Aerobic gram-negative
bacilli (Escherichia coli, P.
aeruginosa, Enterobacter spp.,
and Klebsiella pneumoniae)

Epidemiology of Nosocomial Infections (3)

Nosocomial transmission of
community
acquired, multidrug-resistant
organisms

M. tuberculosis
Salmonella spp.
Shigella spp.
V. cholerae

Root Causes of Nosocomial Infections

Lack of training in basic IC

Lack of an IC infrastructure
and poor IC practices
(procedures)
Inadequate facilities and
techniques for hand hygiene
Lack of isolation precautions
and procedures

Root Causes of Nosocomial Infections (2)

Use of advanced and complex
treatments without adequate
training and supporting
infrastructure, including

Invasive devices and procedures

Complex surgical procedures
Interventional obstetric practices
Intravenous catheters, fluids, and
medications
Urinary catheters
Mechanical ventilators
Inadequate sterilization and
disinfection practices and inadequate
cleaning of hospital

Root Causes of Nosocomial Infections

Use of advanced and complex treatments without
adequate training and supporting infrastructure,
including
Invasive devices and procedures
Complex surgical procedures
Interventional obstetric practices
Intravenous catheters, fluids, and medications
Urinary catheters
Mechanical ventilators

Inadequate sterilization and disinfection practices and

inadequate cleaning of hospital
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Who Serves on the Infection

Control Committee?
The Infection Control Committee is generally
comprised of members from a variety of disciplines
within the healthcare facility. Representation may
include: physicians, nursing staff, infection control
practitioners, quality assurance personnel, risk
management personnel as well as representatives
from microbiology, surgery, central sterilization,
environmental services, etc.
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Infection Control Committee (1)

Membership
Doctors

General physician
Infectious disease specialist
Surgeon
Clinical microbiologist

Infection control nurse

Representatives from other relevant
departments

Laboratory
Housekeeping
Pharmacy and central supply
Administration

Infection Control Committee

Goal
To prevent the spread of infections
within the health care facility
Functions
Addressing food handling, laundry
handling, cleaning procedures,
visitation policies, and direct patient
care practices
Obtaining and managing critical
bacteriological data and information,
including surveillance data

Infection Control Committee

Functions (cont)

Developing and
recommending policies and
procedures pertaining to
infection control
Recognizing and
investigating outbreaks of
infections in the hospital
and community

Infection Control Committee

Intervening directly to
prevent infections
Educating and training
health care workers,
patients, and
nonmedical caregivers
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The Purpose of the Team is to find

solutions
The goal of this
interdisciplinary team is to
bring together individuals with
expertise in different areas of
healthcare. By creating a
diverse group, issues can be
addressed from several angles,
and members can pool their
expertise to develop the best
solutions possible.
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What Does the Infection Control Committee Do?

The role of the
Infection Control
Committee is very
multi-faceted. It
should be involved in
planning, monitoring,
evaluating, updating,
and educating
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What Does the Infection Control

Committee Do?
It sets general infection
control policy and
provides input into
specific infection control
issues. Simply stated, its
function is to prevent
and control nosocomial
infections.
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What Does the Infection Control

Committee Do?
. That is accomplished in a
variety of ways some of which
include: surveillance of
nosocomial infections, product
evaluation, investigation of
infection outbreaks and infection
clusters, development of
infection control procedures for
all departments, staff and
patient education, medical
waste management, etc
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How Does the Infection Control Committee

Prevent and Control Infection?

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Planning
Successful prevention and control
of infection requires careful
planning. The Infection Control
Committee is actively involved
with the planning and
implementation of new
procedures that pose a potential
infection control risk. For example,
it may provide guidance for the
set-up of an endoscopy lab or the
implementation of a new
procedure
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Planning
Its role in the planning
process is to examine the
proposal, identify
potential areas of
concern, and recommend
a course of action that
provides the best
method of infection
control.
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Committee Decides on the Chemical and

Disinfectants we use in the Hospitals
The committee also may provide input into the
selection of chemicals used to manage the
environment, such as detergents and disinfectants. It
may also provide input into the selection of
equipment used to process instruments and
accessories. The multidisciplinary composition of the
committee makes it an ideal place to examine new
product and procedure proposals from several
aspects.
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Monitoring
The Infection Control Committee
also monitors infectious
processes within the healthcare
facility. They track nosocomial
infections and incidents that
have the potential to cause
infections. They review infection
control statistics from the facility
in an effort to minimize risk,
identify problem areas, and
implement corrective actions.
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Monitoring

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When infections do
occur, the committee
undertakes
epidemiological
investigations to
determine the cause of
the problem and
recommends the
necessary education or
changes in protocols.

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Evaluating
Along with monitoring specific
incidents, the Infection Control
Committee also looks at the bigger
picture as it continually strives to
improve processes within the
facility. This is demonstrated by the
regular review of infection control
procedures for all departments. The
committee may also be called upon
to evaluate practices and provide
input regarding products and
protocols.
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Updating
Perhaps one of the biggest
challenges that all Infection
Control Committees face is
keeping current. The constant
advancement of medical
technology introduces changes at
all levels within the healthcare
facility, new bacterial strains
complicate and challenge older
infection control practices, and
new research often requires reexamination of established
procedures
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Updating
The Infection Control
Committee's purpose is to
provide guidance and leadership
through these changes. This
requires that all members of the
team strive to keep abreast of
changes within their area of
expertise. By keeping current,
they can assist the committee as
it works to manage its facility's
infection control policy
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Educating
Finally, as an integral part of its
leadership, the committee must
take an active role in staff
education. That role may be a
hands-on approach or it may be
an advisory role in partnership
with the facility's education
department. However it
functions, the committee must
set direction for staff education
and validation of that education.
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Responsibilities:
1. Advice staff on all aspects of
infection control and maintain a
safe environment for patients and
staff
2. Provide educational programmes
on the prevention of hospital
infection for all hospital personnel
3. Provide a basic manual of
policies and procedures and ensure
that local written guidelines based
on these are in existence
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Responsibilities:
Establish systems of surveillance
of hospital infection in order to
identify at-risk patients and
problem areas that need
intervention. Methods for
surveillance may include case
findings by ward rounds and
chart reviews, reviews of
laboratory reports, and targeted
prevalence of incidence survey
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Responsibilities:
Advise management of
patients requiring special
isolation and control
measures 6. Investigate and
control outbreaks of
infection in collaboration
with medical and nursing
staff
. Ensure that an antibiotic
policy is in existence
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Isolation and Standard Precautions

Whenever possible, avoid crowding wards.
Implement specific policies and procedures for
patients with communicable diseases:
Private rooms and wards for patients with specific
diseases
Visitation policies
Hand washing and use of gloves
Gowns, when appropriate
Masks, eye protection, gowns
Precautions with sharp instruments and needles

Ensuring a Clean Environment

Establish policies and procedures to prevent food and water
contamination
Establish a regular schedule of hospital cleaning with appropriate
disinfectants in, for example, wards, operating theaters, and
laundry
Dispose of medical waste safely
Needles and syringes should be incinerated
Other infected waste can be incinerated or autoclaved for landfill
disposal

Bag and isolate soiled linen from normal hospital traffic

Universal Precautions
Precautions that
protect the
patient/client, coworkers, and
community from
infection
Universal Precautions

Universal Precautions
Universal Precautions
Techniques
Wear gloves when
touching blood
touching mucous
membranes
performing venipuncture
touching body fluids of
any kind

Practice Universal Precautions with

Body fluids
Body Fluids
vaginal fluids or semen
cerebrospinal fluid
pleural fluid (fluid around lung)
pericardial fluid (fluid around
heart)
synovial fluid (fluid in the
joints)
amniotic fluid (fluid around
the fetus)
placenta tissue
saliva with blood in it

Isolation Precautions
Isolation
condition of having limited
contact with others

Protective Isolation
guarding workers and visitors
from danger

Reverse Isolation
guarding the patient from
danger

Types of Isolation
Respiratory Isolation
protection from
airborne droplets

Skin and wound

Isolation
protection from open
wounds, skin drainage

Types of Isolation
Enteric Isolation
solid body wastes

Strict Isolation
complete protection

Blood and body

fluids

Responsibilities:
Coordinate with the
hospital doctors and
administration
(managerial and
nursing), community
health doctors and
nurses and infection
control staff in adjacent
hospitals
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Hand Washing a Great Idea to control and

prevent Infections
Hand Hygiene is of
paramount important to
the Trust and we have
trained designated Hand
Hygiene Champions in
every clinical area who
promote the World Health
Organisations (WHO) 5Moments of Hand Hygiene
standards
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Hand Hygiene
Handwashing is one of the
most effective measures of
reducing infection and all
staff and visitors are asked
to wash their hands or use
the alcohol hand foam l
before and after seeing
relatives or patients. These
facilities are available
throughout our hospitals.
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If you have washed your hands you have contributed your best in
reduction of Nosocomial Infections

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Infection Control Resources

Infection control manuals, protocols, and
training programs (See Participants Guide, annex 1)
CDC websiteprotocols
Engender Health training programweb-based
training for basic infection programs
ICATtool that can be used in low-resource
countries to improve infection control practices
(can be obtained from RPM Plus/MSH)

References
The Infection Control Committee Farrah Lee, BSN, and Natalie Lind,
ACE Infection control today
CDC guidelines

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Attention of Viewers
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 Program Created by Dr.T.V.Rao MD for Benefit

of Medical and Paramedical Professionals in the
Developing World Created from World Wide
Resources
Email
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