Community Medicine V Dr. Mehrdad Askarian MD, MPH Professor of Community Medicine

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Community Medicine VDr. Mehrdad
Askarian MD, MPHProfessor of Community Medicine
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Nosocomial Infections
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Nosocomial infections

• Importance
• Prevalence/incidence
• 5-10 according to hospital, ward, procedures.
• Mortality Morbidity
• High, because of criteria of microorganism
  (resistance, invasion, pathogenesis) and host
  factors.
• Mortality rate of 3
• Costs
• Average 4.5 days of extra admission (1-12 days)

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Nosocomial infections

• All patients undergoing surgery admitted from
  March 1, 1999, to February 28, 2000, to the
  38-bed general surgery ward within a university
  hospital in Shiraz, Iran, were included in this
  study. The study was planned as a
  pairwise-matched case-control study nested in
  cohort design. A case was defined as any patient
  with 1 of 4 of the following nosocomial
  infections urinary tract infection surgical
  site infection bloodstream infection or
  pneumonia, whereby definitions for the nosocomial
  infections were on the basis of National
  Nosocomial Infection Surveillance system
  definitions. For each patient, an appropriate
  match was selected, which resulted in 69 pairs of
  study patients.
• Askarian et al. National Nosocomial Infection
  Surveillance System Based Study in Iran
  Additional Hospital Stay Attributable to
  Nosocomial Infections. Am J Infec Control 2003
  31465-468.

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Nosocomial infections

• Results The total incidence of nosocomial
  infection during the study period was 17.59. The
  mean extra length of hospitalization as a result
  of all major kinds of nosocomial infections was
  6.62 days total, which was obtained using 4.4,
  5.33, 8.73, and 9.2 extra days for urinary tract
  infection, pneumonia, surgical site infection,
  and bloodstream infection, respectively.
• Askarian et al. National Nosocomial Infection
  Surveillance System Based Study in Iran
  Additional Hospital Stay Attributable to
  Nosocomial Infections. Am J Infec Control 2003
  31465-468.

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Nosocomial infections

• This study was conducted over 11 months, from
  21st December 2000 to 21st November 2001. All the
  patients who were admitted for more than 48 h and
  did not have evidence of infection at the time of
  admission were included in the study. For
  diagnosis of urinary tract and bloodstream
  infections, the standard definitions from the
  Center for Diseases Control (CDC) were used.
• Askarian M, et al. Incidence of Urinary Tract and
  Blood Stream Infections in Ghotbeddin Burn
  Center, Shiraz 2000-2001. Burns, 2003,
  29(5)455-459.

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Nosocomial infections

• Of the total 106 qualifying patients, 91 study
  patients acquired nosocomial infections (85.85).
  Urinary catheter-associated urinary tract
  infection (UC-UTI) rate was 30 per 1000 urinary
  catheter days and IV line-associated bloodstream
  infection (IV line-BSI) rate was 17 per 1000 IV
  line days.
• Askarian M, et al. Incidence of Urinary Tract and
  Blood Stream Infections in Ghotbeddin Burn
  Center, Shiraz 2000-2001. Burns, 2003,
  29(5)455-459.

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Nosocomial infections

• The study was conducted prospectively during a
  period of 11 months from December 2000 to
  November 2001. All patients presenting with no
  signs and symptoms of infection within the first
  48 hours of admission were included and examined
  for detecting 4 types of nosocomial infection
  burn infection, urinary tract infection,
  pneumonia, and bloodstream infection. Centers for
  Disease Control and Prevention National
  Nosocomial Infection Surveillance system criteria
  were applied.
• Askarian M, et al. Infection Rate and Outcome of
  Female Burn Patients in Shiraz, Iran Am J Infect
  Control 2004 33 23-26

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Nosocomial infections

• One hundred six female patients met the inclusion
  criteria. Ninety-one (85.8) acquired at least 1
  infection (44.7 per 1000 patient-days), including
  91 with burn infection, 28 with urinary tract
  infection, 56 with pneumonia, and 30 with
  bloodstream infection, which gives 446.7, 137.5,
  and 275, and 147.3 infections per 1000
  patient-days, respectively.
• Askarian M, et al. Infection Rate and Outcome of
  Female Burn Patients in Shiraz, Iran Am J Infect
  Control 2004 33 23-26.

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Nosocomial infections

• The lack of separation between hazardous and non-
  hazardous waste, an absence of necessary rules
  and regulations applying to the collection of
  waste from the hospital wards and the on-site
  transport to a temporary storage location, a lack
  of proper waste treatment, disposal of hospital
  waste along with municipal garbage, nsufficient
  training of personnel, insufficient personal
  protective equipment and lack of knowledge
  regarding the proper use of such equipment, were
  the main findings.
• Askarian M, et al. Hospital Waste Management
  Status in University Hospitals of the Fars
  Province, Iran. Int J Environ Health Res.
  200414295-305.

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Nosocomial infections

• The results indicated that the waste generation
  rate is 4.45 kg/bed/day, which includes 1830 kg
  (71.44) of domestic waste, 712kg (27.8) of
  infectious waste, and 19.6 kg (0.76) of sharps.
  Segregation of the different types of waste is
  not carried out perfectly. Two (13.3) of the
  hospitals use containers without lids for onsite
  transport of wastes. Nine (60) of the hospitals
  are equipped with an incinerator and six of them
  (40) have operational problems with the
  incinerators. In all hospitals municipal workers
  transport waste outside the hospital premises
  daily or at the most on alternative days. In the
  hospitals under study, there arent any training
  courses about hospital waste management and the
  hazards associated with them.
• Askarian M, et al. Results of A Hospital Waste
  Survey In Private Hospitals in Fars Province,
  Iran. Waste Manag. 200424347-52.

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Nosocomial infections

• A survey of 1,048 healthcare workers (HCWs) at
  eight Shiraz University Medical Sciences
  Hospitals revealed baseline assessment scores in
  infection control isolation precaution knowledge,
  attitudes and practices below acceptable safety
  levels. An important practice of routine
  handwashing before and after glove use was
  reported by less than half of all respondents.
• Askarian M, et al. Assessment of knowledge,
  attitudes and practices Regarding isolation
  precautions among Iranian health care workers.
  Infect Control Hosp Epidemiol 200526105-108).

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Infection Control Isolation Precautions
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• Standard Precautions
• Airborne Precautions
• Droplet Precautions
• Contact Precautions

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Standard Precautions

• Wash Hands
• Before and after patient care.
• Before and after using gloves.
• Between patient contact.

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Standard Precautions

• Wear Gloves
• When touching blood, body fluids, secretions,
  excretions and contaminated items.
• Before touching mucous membranes and nonintact
  skin.

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Standard Precautions

• Mask / Eye Protection.
• To protect mucous membranes of the eyes, nose
  mouth when procedures activities are likely to
  generate splashes or sprays of blood body
  fluids.

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Standard Precautions

• Wear Gown
• To protect skin clothing during procedures
  activities are likely to generate splashes or
  sprays of blood body fluids.
• Remove soiled gown immediately wash hands.

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Standard Precautions

• Take Care
• To prevent injuries when using needles, scalpels
  other sharp instruments.
• When handling sharp instruments after procedures.
• When cleaning used instruments.
• When disposing of used needles.

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Airborne Precautions

• Patient placement
• Private room.
• Negative pressure room.
• Door closed.

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Airborne Precautions

• Wear Mask
• Tuberculosis
• Chicken pox (Varicella), Measles (Rubeola)
  Immune persons, no mask required.
  Susceptible persons, not to enter room.

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Airborne Precautions

• Patient transport
• Limit transport of patient to essential purpose
  only.
• Use surgical mask on patient during transport.
• Notify area receiving patient.

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Droplet Precautions

• Patient placement
• Private room if possible.
• If cohorting patients, maintain separation of
  three feet between patients.

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Droplet Precautions

• Wear mask
• Wear regular mask if within three feet of
  patient.

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Droplet Precautions

• Patient transport
• Limit transport of patient to essential purpose
  only.
• Use surgical mask on patient during transport.
• Notify area receiving patient.

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Contact Precautions

• Patient placement
• Private room. Yes No

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Contact Precautions

• Wear gloves
• wear gloves when entering room.
• Remove gloves before leaving patient room.

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Contact Precautions

• Wash hands
• Wash hands with antibacterial agent after glove
  removal. Avoid recontamination of hands.

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Contact Precautions

• Wear gown
• Wear gown when entering patient room if you
  anticipate contact with patient or environment.
• Remove gown before leaving room.

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Contact Precautions

• Patient transport
• Limit transport of patient to essential purposes
  only.
• During transport, ensure precautions are
  maintained to minimize risk of transmission of
  organism.

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Contact Precautions

• Patient care equipment
• Dedicate use of noncritical patient care
  equipment to a single patient.
• Clean disinfect any common equipment between
  patients.

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Nosocomial infections
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• Any Comments or
• Questions?

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DISCUSSION QUESTIONS??
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Thank you for your kind attention