HOSPITAL INFECTION CONTROL

Cecilia S. Montalban, MD, MScCTM

Philippine Hospital Infection Control Society (PHICS), Inc.

INFECTION
the state or condition in which the body or part of the body is invaded by a pathogenic agent (bacteria, virus, parasites etc.) which under favorable conditions multiplies and produces injurious effects

Philippine Hospital Infection Control Society (PHICS), Inc.

NOSOCOMIAL INFECTION
latin word nosocomium meaning hspital synonymous to hospital-acquired infection infection acquired 48 hours after admission to hospital (not present or incubating at the time of admission) acquired while in the hospital and developed after discharge

Philippine Hospital Infection Control Society (PHICS), Inc.

Common Sites of Nosocomial Infections

Urinary tract Respiratory tract Gastrointestinal Blood stream Skin, Wound, Burn Surgical wound infection Others
Philippine Hospital Infection Control Society (PHICS), Inc.

Factors Promoting Nosocomial Infection

age duration of hospitalization surgery (type of operation) immune status: chemotherapy, radiation therapy, malignancy diagnostic technique/ procedures environment personnel patient

Philippine Hospital Infection Control Society (PHICS), Inc.

The C ST of Nosocomial Infection

PERSONNEL Need for hospitalization Income loss Pain and suffering Disfigurement/Disability Death

Philippine Hospital Infection Control Society (PHICS), Inc.

The C ST of Nosocomial Infection

INSTITUTIONS Loss of revenue Extra duty Liability insurance Malpractice Reputation

Philippine Hospital Infection Control Society (PHICS), Inc.

EXTRA C STS BY TYPE OF INFECTION

BSI
Extra days confinement Added cost

Pneumonia
11

UTI
13

15 US$ 2,619

US$ 2,051 US$ 1,970

Rosenthal and Migone. Nosocomial Infections Costs And Extra Days In Intensive Care Units In Argentina. Prospective Cohort Matched Cases. IV Infections Control And Hospital Epidemiology Pan American Congress. 2002, Cancun, Mexico.

Philippine Hospital Infection Control Society (PHICS), Inc.

How do infections occur in hospital setting ?

AGENT

SUSCEPTIBLE HOST

MEANS OF TRANSMISSION

Philippine Hospital Infection Control Society (PHICS), Inc.

How do infections occur in hospital setting ?

AGENT

Philippine Hospital Infection Control Society (PHICS), Inc.

AGENTS
GRAM NEGATIVE RODS Escherichia coli Klebsiella sp. Pseudomonas aeruginosa Acinetobacter sp. Enterobacter sp. GRAM POSITIVE COCCI Staphylococcus aureus Staphylococcus epidermidis Enterococci OTHERS Fungi Candida sp.; Aspergillus sp. Protozoans Mycobacterium tuberculosis Pneumocystis carinii Anaerobes

Philippine Hospital Infection Control Society (PHICS), Inc.

Sources of Agents of Nosocomial Infections

EXOGENOUS Hands Instruments Catheters Respiratory equipments Transfusions IV system Linen Air ENDOGENOUS Oropharynx Respiratory Gastrointestinal Skin

Philippine Hospital Infection Control Society (PHICS), Inc.

Factors Promoting Endogenous Infections Operations Catheters Foreign bodies Chemotherapy Immunosuppression Pre-existing disease

Philippine Hospital Infection Control Society (PHICS), Inc.

How do infections occur in hospital setting ?

AGENT

MEANS OF TRANSMISSION

Philippine Hospital Infection Control Society (PHICS), Inc.

Means of Transmission of Nosocomial Infections

Contact Airborne Droplet Vector Vehicle

direct or indirect measles, varicella, TB meningococcemia insects or animals food, water, blood, medication

Philippine Hospital Infection Control Society (PHICS), Inc.

MEANS OF TRANSMISSION OF NOSOCOMIAL INFECTIONS

CONTACT
A. Direct Contact - occurs when one person touches another - direct contact is an ongoing process in the hospital - best vehicle : Hands
Philippine Hospital Infection Control Society (PHICS), Inc.

MEANS OF TRANSMISSION OF NOSOCOMIAL INFECTIONS

CONTACT
B. Indirect Contact - occurs when a person touches an inanimate object contaminated by an infected patient

Philippine Hospital Infection Control Society (PHICS), Inc.

How do infections occur in hospital setting ?

AGENT

SUSCEPTIBLE HOST

MEANS OF TRANSMISSION

Philippine Hospital Infection Control Society (PHICS), Inc.

Factors that Increase Host Susceptibility to Nosocomial Infections

Chronic underlying diseases Immune deficiency states
Malignancies Therapeutic measures Immunosuppression Antibiotic therapy

Invasive devices Surgery Age

Philippine Hospital Infection Control Society (PHICS), Inc.

AGENT
Bacteria Virus Fungi

Means of Transmission
CONTACT AIRBORNE DROPLET VEHICLE VECTOR

Susceptible Host
Disease

Philippine Hospital Infection Control Society (PHICS), Inc.

BASIC PRINCIPLES IN INFECTION CONTROL

Philippine Hospital Infection Control Society (PHICS), Inc.

Susceptible HOST The CHAIN of INFECTION AGENT

Means of Transmission

Philippine Hospital Infection Control Society (PHICS), Inc.

Susceptible HOST

Breaking the Chain of Infection

AGENT

Means of Transmission

Philippine Hospital Infection Control Society (PHICS), Inc.

Basic Principles in Infection Control

The hands should be washed after handling infectious materials (e.g. bed linen, dressings, secretion and excretions). The skin of the patient should be disinfected before invasive procedures Emphasize HANDWASHING for personal hygiene

Philippine Hospital Infection Control Society (PHICS), Inc.

Philippine Hospital Infection Control Society (PHICS), Inc.

Basic Principles in Infection Control

Rational Use of Devices - Avoiding or removing factors that impair host defenses. - Invasive devices should be avoided or should be removed as soon as possible

Philippine Hospital Infection Control Society (PHICS), Inc.

Basic Principles in Infection Control

Isolation Techniques based on method of spread Protective or Reverse Isolation Rationale: decreasing the contact of the immunocompromised host to potential pathogens Immunotherapy, Immunizations and other methods of reconstituting patients immune response may be attempted

Philippine Hospital Infection Control Society (PHICS), Inc.

Basic Principles in Infection Control The environment should be HOSTILE to the multiplication of pathogens, i.e. clean, dry, exposed to light and well ventilated. All infectious materials (e.g. linen, clinical waste, sharps) should be safely contained, decontaminated or destroyed.

Philippine Hospital Infection Control Society (PHICS), Inc.

Basic Principles in Infection Control

All instruments and equipment should be clean and dry. Invasive items should be sterilized and items in contact with mucous membranes, body fluids and potentially infectious materials should be disinfected. Food should be hygienically prepared, properly cooked and stored at low temperatures until used.

Philippine Hospital Infection Control Society (PHICS), Inc.

Basic Principles in Infection Control

Susceptible patients or sites should be protected from pathogenic microorganisms: i.e. aseptic technique practice during wound dressing, or procedures Use of disposable supplies and equipment in an attempt to limit the spread of infection by this means Control of insects and rodents that serve as vectors in the spread of microorganisms
Philippine Hospital Infection Control Society (PHICS), Inc.

Hand Hygiene Rational use of Devices Isolation Immunization, Immunotherapy Prophylaxis

Susceptible HOST

Hand Hygiene Aseptic Technique practice Environmental Care Disinfection and Sterilization

Breaking the Chain of Infection

AGENT

Means of Transmission
Hand Hygiene Environmental Care Waste management Disinfection and Sterilization

Philippine Hospital Infection Control Society (PHICS), Inc.

The Health Care Worker (HCW) should be aware of how infection is transmitted and the factors involved in the process The HCW should be able to implement the MOST effective and applicable measures to prevent and control infection in his place of work The HCW should have the proper attitude of infection control

Philippine Hospital Infection Control Society (PHICS), Inc.

Hospital Infection Control Committee

Philippine Hospital Infection Control Society (PHICS), Inc.

Philippine Hospital Infection Control Society (PHICS), Inc.

Hospital Infection Control Committee

Organizational Structure Under the office of the Medical Director
Infection Control Team Chairperson Infection Control Physician Infection Control Nurse Reps from different clinical departments Auxiliary members from Employee Health Service,

Engineering, Pharmacy, Central Sterilization and Supply Department and Housekeeping Department

Philippine Hospital Infection Control Society (PHICS), Inc.

Hospital Infection Control Committee

Objective To facilitate the effective prevention, detection, and control of healthcare associated infection among patients, healthcare workers and visitors.
Philippine Hospital Infection Control Society (PHICS), Inc.

Infection Control Committee

Responsibilities: Formulates, updates, and implements infection control policies and procedures: - Hand hygiene - Dietary - Disinfection & sterilization - Linen & Laundry - Isolation policy - Waste Management - Antibiotic Use - Environmental Care - Personnel Health
Philippine Hospital Infection Control Society (PHICS), Inc.

Infection Control Committee

Responsibilities:
Surveillance - nosocomial infection - antimicrobial resistance - proper infection control practice - personnel health - outbreaks - environment

Philippine Hospital Infection Control Society (PHICS), Inc.

Infection Control Committee

Training and education of healthcare staff
Conducts orientation of new staff Conducts activities for updates on infection control for staff regularly Disseminates necessary information

Philippine Hospital Infection Control Society (PHICS), Inc.

Organizational Structure; ICC

Medical Director ICC----------------------------------

Nursing Service

Medical Services

Administrative

Philippine Hospital Infection Control Society (PHICS), Inc.

Membership of the Infection Control Committee

Chairperson Infection control doctor Infection control nurse Representative from:

Administration Clinical departments (medicine, pediatrics, surgery,

obstetrics and gynecology, Infectious Disease Section) Microbiology laboratory Nursing service
Philippine Hospital Infection Control Society (PHICS), Inc.

Membership of the Infection Control Committee

Representative from:
Pharmacy Employee Health Service

Central Sterilization and Supply Department

Engineering Dietary Department Housekeeping Linen and laundry Waste Management
Philippine Hospital Infection Control Society (PHICS), Inc.

The Infection Control Team

IC Physician IC Nurse Microbiologist Epidemiologist

Philippine Hospital Infection Control Society (PHICS), Inc.

The Infection Control Team

An effective ICT:

Maintains direct access to a representative of the Hospital Director/Administrator Responsible to the ICC Functions on a daily basis Has access to appropriate facilities to enable it to perform its duties Have an efficient mechanism of reporting significant hospital outbreaks
Philippine Hospital Infection Control Society (PHICS), Inc.

The Infection Control Team

Responsibilities
Educates, trains, and advises staff on all aspects

of infection control
Conducts surveillance activities: Nosocomial infections Antibiotic resistance Infection control practices
Philippine Hospital Infection Control Society (PHICS), Inc.

Establishing An Infection Control Program

Identify interested and key hospital personnel as members of the ICC/ICT Accomplish a written description of the program (Infection Control Plan)
Goals, objectives, structure Specific surveillance, prevention, control,

education, and training activities

Philippine Hospital Infection Control Society (PHICS), Inc.

Establishing An Infection Control Program

Formulate written policies and procedures

study existing practices modify existing policies as needed consider difficulties during implementation after hospital-wide consultation Implement changes gradually Have the cooperation of the staff

Philippine Hospital Infection Control Society (PHICS), Inc.

Establishing An Infection Control Program

Formulate written policies and procedures

simple, easy to follow, common sense consider costs and availability of supplies

maintain standard of care

incorporate written policies in the IC manual Monitor and evaluate periodically

Philippine Hospital Infection Control Society (PHICS), Inc.

Establishing An Infection Control Program

Disseminate information Implement and monitor Annual evaluation on the IC program

Assess the activities Assess accomplishments Identify any changes in goals, objectives,

structure Assess the value of the program to the hospital

Philippine Hospital Infection Control Society (PHICS), Inc.

INFECTION CONTROL is

Philippine Hospital Infection Control Society (PHICS), Inc.

Infection Control should be

..... a WAY of LIFE!

Philippine Hospital Infection Control Society (PHICS), Inc.

Thank You!

Philippine Hospital Infection Control Society (PHICS), Inc.