The impact of HCAI

Health Care-Associated Infections
in King Faisal Hospital
Christine Mukashema
Learning Objectives
• To be aware about the HCAI problem
• Describe principles of control measures
What is Health Care-Associated Infections?
• Also referred to as “nosocomial” or “hospital”
infection
“An infection occurring in a patient during the
process of care in a hospital or other health-care
facility which was not present or incubating at the
time of admission. This includes infections
acquired in the health-care facility but appearing
after discharge, and also occupational infections
among health-care workers of the facility”
Why this presentation


HCAI places a serious disease burden and significant
economic impact on patients and health-care
systems
No health-care facility, no country, no health-care
system in the world can claim to have solved the
problem
Estimated rates of HCAI worldwide
– Worldwide:
• over 1.4 million people suffering HCAI
– In developed world:
• 5–10% of patients acquire one or more infections
– In developing countries:
• risk of HCAI is 2–20 times higher than in developed
countries
• exceed 25% of patients affected by HCAI
– In intensive care units
• 30% of patients
• 44% of attributable mortality
Most frequent KCAI in KFH
2012
2011
Klebsiella
17.6%
Klebsiella
19.5%
Pseudomonas
7.6%
Acinetobacter:
10.5%
Acinetobacter
5.5%
Pseudomonas:
7.6%
Staphylococcus Aureus
8.2%
Staphylococcus Aureus
7.4%
E.Coli
37.7%
E.Coli: 34.7%
34.7%
Infection rate
9.4%
Infection rate
11%
Most frequent in KFH
The Respiratory tract:
– procedures and equipment associated with intubation,
ventilator support and tracheotomy
– management of TB…
Urinary tract:
– procedures and equipment associated with urinary
drainage systems
– indwelling catheters
– catheters and their care
Intravascular devices:
– procedures and equipment associated with peripheral
venous lines, CVCs….
Surgical wounds:
– procedures and equipment associated with their care
Some HAI in ICU(2011- May2012)
SPECIMEN
KLEBSIELLA
PSEUDOMONAS
ACIENTOBACTER
BLOOD
3
1
2
CSF
4
0
2
FLUID
6
4
22
PUS
9
7
2
SPUTUM
1
3
1
URINE
8
3
5
Total
31
18
34
Some HAI in Surgical (2011- May 2012)
SPECIMEN
KLEBSIELLA
PSEUDOMONAS
ACIENTOBACTER
BLOOD
5
5
5
CSF
1
0
1
FLUID
4
6
18
PUS
9
14
18
SPUTUM
1
1
3
URINE
15
8
5
TISSUE
Total
2
35
34
52
February
March
April
May
June
July
August
Total
Surgical
19
15
18
30
12
26
22
17
159
ICU
15
13
10
6
9
1
5
14
68
Medical
15
16
10
11
9
7
23
15
106
Ward Names
Percentag
e
January
Organisms isolated during 8 months by ward
33%
Paediatric
7
9
NICU
7
7
3
15
1
5
2
1
9
3
2
10
19
10
77
14%
22%
16%
2%
Urusaro
2
Maternity
4
HDU
8
Haemodialysis
Total
2
3
2
2
4
2
2
3
21
2%
4.3%
5
1
2
1
8
25
5%
4
2
1
2
10
2%
48
59
76
70
485
1
69
60
49
65
Where we can found those Microbes?
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•
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•
•
•
•
•
Bed rails
Bedside tables
Ventilators
Infusion pumps
Mattresses
Pillows
Air humidifiers
Patient monitors
•
•
•
•
•
•
•
•
X-ray view boxes
Curtain rails
Curtains
Equipment carts
Sinks
Ventilator circuits
Floor mops
HCWs
Possible causes of HCAI in KFH
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Poor Hand Hygiene
Knowledge of the policies, guidelines/standards
No in ward training
No orientation in the department
High turnover of staff
Lack of staff
Negligence/ignorance
Stock outs / recycling/ lack of instruments
Staff motivation
Cleaning of instruments/ soaking of instruments
Dilution of chemicals used for cleaning- bed area and the instruments
No guideline on screening patients transferred from other institutions
Personal hygiene – staff uniform and cleaning
Labeling and changing of invasive
Isolation Precautions (sometimes not possible)
Use of PPE
Frequent stock outs of IPC items
Antibiotic sensitivity
• Bad usage of antibiotic causes drug resistance
• Not given in
– Appropriate time
– Appropriate dose
– Appropriate course
– Appropriate antibiotics
Most frequent infection sites & their risk factors
URINARY TRACT INFECTIONS
Urinary catheter
Urinary invasive procedures
Advanced age
Severe underlying disease
Urolitiasis
Pregnancy
Diabetes
SURGICAL SITE INFECTIONS
Inappropriate antibiotic prophylaxis
Incorrect surgical skin preparation
Inappropriate wound care
Surgical intervention duration
Type of wound
Poor surgical asepsis
Diabetes
Nutritional state
Immunodeficiency
Lack of training and supervision
34%
13%
LACK
OF
Most
common
sites
of HCAI
HAND
and the risk factors
HYGIENE
17%
14%
LOWER RESPIRATORY TRACT INFECTIONS
Mechanical ventilation
Aspiration
Nasogastric tube
Central nervous system depressants
Antibiotics and anti-acids
Prolonged health-care facilities stay
Malnutrition
Advanced age
Surgery
Immunodeficiency
BLOOD INFECTIONS
Vascular catheter
Neonatal age
Critical care
Severe underlying disease
Neutropenia
Immunodeficiency
New invasive technologies
Lack of training and supervision
Hand transmission
– Hands are the most
common vehicle to
transmit health careassociated pathogens
– 5 sequential steps to
transmit of health
care-associated
pathogens from one
patient to another via
health-care workers’
hands
5 stages of hand transmission
One
Two
Three
Four
Five
Germs
present on
patient skin
and
immediate
environment
surfaces
Germ
transfer
onto healthcare
worker’s
hands
Germs
survive on
hands for
several
minutes
Suboptimal
or omitted
hand
cleansing
results in
hands
remaining
contaminated
Contaminate
d hands
transmit
germs via
direct
contact with
patient or
patient’s
immediate
environment
The impact of HCAI
HCAI can cause:
– more serious illness
– prolongation of stay in a
health-care facility
– long-term disability
– excess deaths
– high additional
financial burden
– high personal costs on
patients and their
families
Study on the Efficacy of Nosocomial
Infection Control (SENIC)
• >30% of HCAI are preventable
Relative change in NI in a 5 year period (1970–1975)
30
20
10
%
0
9%
LRTI
14%
SSI
19%
UTI
26%
18%
BSI
Total
With
infection
control
-10
-20
-30
-40
Without
infection
control
-27%
-35%
Haley RW et al. Am J Epidemiol 1985
-31%
-35%
-32%
Prevention of HCAI
– At least 50% of HCAI could be prevented
– Validated and standardized prevention strategies
have been shown to reduce HCAI
– Most solutions are simple and not resourcedemanding and can be implemented in
developed, as well as in transitional and
developing countries
Possible solutions
1.
2.
3.
4.
5.
6.
7.
A proper orientation in all departments
Regular training of staff in IPC
Monthly IPC audit, hand washing audit
Avail all necessary items from the management
Motivation of staff
A proper reporting of infections
Administration to facilitate repair and/or
establishment of hand washing facilities in all areas
8. To put in place some measures if policies/
guidelines are not followed
Possible solutions
9. Implementation of IPC policies and guidelines in all
department
10. To procure all necessary items and equipments
needed
11. To recruit enough nurses
12. To follow policy on the use of antibiotics in the
hospital
13. Environmental decontamination
14. The HoU, NUMs should follow closely their staff
(close supervision)
Why should you clean your hands?
– Any health-care worker, caregiver or person
involved in patient care needs to be concerned
about hand hygiene
– Therefore hand hygiene concerns you!
– You must perform hand hygiene to:
– protect the patient against harmful germs carried on your
hands or present on his/her own skin
– protect yourself and the health-care environment from
harmful germs
The “My 5 Moments for Hand
Hygiene” approach