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Title: 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

54
  • Created by Dr.T.V.Rao MD for e learning
    resources for Infection Control Personal in the
    Developing World
  • Email
  • doctortvrao_at_gmail.com
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