Curriculum vitae

1. Nama Lengkap & gelar Dr. dr. Maimun Zulhaidah Arthamin, M.Kes, Sp.PK(K)
2. Jenis Kelamin Perempuan
3. Tempat, Tanggal Lahir Sidoarjo, 26 Mei 1970
4. Alamat Perumahan Bumi Palapa Malang
5. No. telp/HP 0341-409393/081233152700

No. Nama pekerjaan/jabatan Periode tahun

1. Staf pendidik/SMF Departemen Patologi Klinik FKUB – 1997 - sekarang
Instalasi Laboratorium Sentral RSSA
2. Ketua PDS PatKLIn Cabang Malang 2019 - 2022
3. Pengurus PERDALIN Cabang Malang Raya 2021 - 2024
4. Penanggungjawab Laboratorium RS Wava Husada 2008 – sekarang
Kepanjen Malang
5. Penanggungjawab Laboratorium RS Lavalette Malang 2015 - sekarang
 Epidemiology and
Transmission of Health
Care Associated
Infections

Maimun Zulhaidah Arthamin

PERDALIN Cabang Malang Raya
Pelatihan PPI Dasar
1 September 2022
Introduction
• Health care associated infections are infections that patients acquire, while
they are in contact with the healthcare system.
• Contact includes all procedures associated with:

diagnostics
treatment

care

rehabiltation
• The spectrum of health care associated infections ranges from
simple common colds to life threatening sepsis with multidrug
resistant organisms.
• With the above definition, around 10 % of patients on average will
become infected while they are in contact with the health care
system.
• Health care associated infections also include occupational
infectious diseases acquired by health care workers.
 Microorganisms:
Multi-drug resistance
Virulence factors

Host factors: Procedures:

Old age Health care Diagnostics
Debilitation associated infections Therapy
Immunosuppression Care
Rehabilitation

Hospital setting:
Space
Ventilation
Cleanliness

Fig. 1. Factors determining health care associated infections.

Fig. 1. Factors determining health care associated infections.
This aim of this paper is to give a comprehensive survey of the more important sources of
Epidemiology
Epidemiologi berasal dari kata yunani, Epi= diatas, Demos= masyarakat
dan Logos= ilmu
ECDC, 2016-2017
• Peningkatan signifikan dalam kasus COVID-19 di rumah sakit selama pandemi
dapat membawa risiko penularan HAI dan menyebabkan wabah.
• Petugas kesehatan berada pada risiko terbesar dibandingkan dengan yang lain
dan bisa berperan dalam penularan ke rumah sakit. Sampai saat ini, besaran
dan faktor risiko infeksi di lingkungan fasilitas kesehatan tidak diketahui dalam
penularan virus SARS-CoV-2.
• Infeksi COVID-19 dalam jumlah yang sangat besar tidak hanya dapat
melumpuhkan sistem kesehatan tetapi juga dapat berkontribusi pada
peningkatan morbiditas dan mortalitas.
• Ancaman COVID-19 berdampak pada staf kesehatan, tetapi juga
meningkatkan keterpaparan keluarga mereka. Namun demikian, setelah
dilakukan pencegahan dan pengendalian infeksi secara menyeluruh, tingkat
infeksi nosokomial dapat menurun.
Distribution of all Pathogens Reported to NHSN,
2015-2017

Pathogen distributions for adult HAIs combined: central line-

associated bloodstream infections (CLABSIs), catheter-associated
urinary tract infections (CAUTIs), possible ventilator-associated
pneumonias (PVAPs), and surgical site infections (SSIs) attributed
to inpatient procedures. Additional methods can be found in the
full report, here: https://doi.org/10.1017/ice.2019.296
Distribution of all Pathogens
Reported to NHSN, 2015-2017,
adult
Pathogen distributions for pediatric HAIs combined: central
line-associated bloodstream infections (CLABSIs), catheter-
associated urinary tract infections (CAUTIs), ventilator-
associated pneumonias (VAPs), and surgical site infections
(SSIs) attributed to inpatient procedures. Additional methods
can be found in the full report, here:
https://doi.org/10.1017/ice.2019.297
2015-2017 Pediatric
Antimicrobial
Resistance (AR) Report
Online Supplement:

Distribution of all
Pathogens Reported to
National Healthcare
Safety Network
(NHSN), 2015-2017
2020 National and State Healthcare-Associated
Infections (HAI) Progress Report

• The 2020 annual HAI Progress Report demonstrates that

significant increases are observed for acute care facilities in the
2020 annual SIRs for CLABSI, MRSA and VAE when compared to
2019.
• Significant decrease was observed in the C. difficile national SIR.
• Decreases in the nominal values of the SSIs following colon and
abdominal hysterectomy SIRs, which are both significant.
• The SIR is the ratio of the observed number of infections (events) to the
number of predicted infections (events) for a summarized time period.
• An SIR of 1, which is the national baseline SIR, indicates the same number of
predicted infections were observed by the facility.
• An SIR lower than 1, indicates fewer infections were observed compared to
what was predicted.
• SIR greater than 1 indicates more infections were observed than predicted.
• The standardized utilization ratios (SURs), which measure device use by
comparing the number of observed device days to the number of predicted
device days.
• The SIR and SUR metrics are calculated using the 2015 national baseline and
risk adjustment methodology.
The impact of COVID-19 on HAI incidence
• A report from the National Healthcare Safety Network (NHSN) found
significant increases in central-line–associated bloodstream infections
(CLABSIs) during the early months of the pandemic
• Nationally, from 2015 to 2019, there have been consistent, significant
reductions in the SIRs for CLABSIs, catheter-associated urinary tract infections
(CAUTIs), and Clostridioides difficile infection (CDI) laboratory-identified
(LabID) events.
• Some significant year to year decrease in methicillin-resistant Staphylococcus
aureus (MRSA) bacteremia LabID events decrease since 2010
• Conversely, there has been minimal change in the occurrence of ventilator -
associated events (VAEs).
Fig. 2. Changes in the 2020 national healthcare-associated infection (HAI) standardized infection ratios (SIRs) for
acute-care hospitals, compared to respective 2019 quarters. Weiner-Lastinger,
LM, et al., Infection Control & Hospital Epidemiology (2022), 43, 12–25
• The analysis of the 2020 quarterly ACH SIRs found significant increases
in CLABSI, CAUTI, VAE, and MRSA bacteremia, compared to 2019.
• The largest increases occurred during quarter 4 of 2020 (2020Q4). Data
showed an overall 47% increase in CLABSIs across all location types for
2020Q4 compared to 2019Q4; ICUs observed a 65% increase and select
inpatient wards observed a 16% increase.
• For CAUTIs, a 19% overall increase was observed in 2020Q4 with ICUs
experiencing a 30% increase.
• For VAE, an overall increase of 45% was observed across all location
types in 2020Q4 compared to 2019Q4. The largest increase in VAE was
observed in ICUs (44%), followed by the adult inpatient wards (35%).
• A longer patient length-of-stay, additional comorbidities and higher patient
acuity levels, and a longer duration of device use in 2020 could have
contributed to an overall increased risk of a device-assoicated infection during
the pandemic.
• In addition, some studies identified an increased risk of ventilator-associated
conditions in critically ill COVID-19 patients.
• The characteristic worsening of respiratory status in some patients with COVID-
19 resulted in an increase in the number of hospitalized patients in 2020 that
required ventilation, and an increase in patients’ average duration of
ventilation, both of which could have contributed to an increased risk of VAE.
• Almost all states previously identified by CDC with a high COVID-19 hospital
admission burden observed increases in their 2020-Q2 CLABSI and VAE SIRs
compared to 2019, most of which were statistically significant.
• Preliminary data for 2020-Q4 showed a large increase of 34% in the
national MRSA bacteremia SIR compared to 2019-Q4.
• There were 2,715 MRSA bacteremia events reported for 2020-Q4,
which is 41% higher than the number of events reported by the same
set of hospitals in 2019-Q4.
• A previous study found that device-associated infections, particularly
those related to centrallines, are a common source of MRSA
bacteremia; thus, the increase in MRSA bacteremia in 2020 is possibly a
result of inadequate central line insertion and maintenance practice.
• Preliminary NHSN data show no substantial changes in 2020,
compared to 2019, in the proportion of CLABSIs caused by S.
aureus, or in the proportion of S. aureus CLABSIs that are
resistant to methicillin (data not shown).
• S. aureus has been identified as a common cause of secondary
bacterial infection in COVID-19
Decreases in the CDI SIRs during 2020 compared to
2019

environmental
hand hygiene patient isolation
cleaning

continued inpatient decline in

antimicrobial outpatient
use of PPE
stewardship antibiotic
programs prescribing
• Substantial increases in CLABSIs, CAUTIs, VAEs, and MRSA
bacteremia were observed.
• The year 2020 marked an unprecedented time for hospitals,
many of which were faced with extraordinary circumstances
of increased patient caseload, staffing challenges, and other
operational changes that limited the implementation and
effectiveness of standard infection prevention practices.
Nationally, among acute care hospitals, the 2020
annual highlights in this report include:

• Overall, about 24% increase in CLABSI between 2019 and 2020

• Largest increase in ICU (50%)
• Overall, there was no significant change in CAUTI between 2019
and 2020
• About 10% increase observed in ICU
• Overall, there was a 35% increase in VAE between 2019 and
2020
• About 34% increase observed in ICU
• About 60% increase observed in ward
• Overall, there was 5% decrease in SSI, between 2019 and 2020.
• About 9% decrease in abdominal hysterectomy SSIs
• About 5% decrease in colon surgery SSIs
• There was a 15% increase in hospital onset MRSA bacteremia
between 2019 and 2020
• About 11% decrease in hospital onset C. difficile infections
between 2019 and 2020
Transmission
Figure. Routes for
healthcare-associated
infection transmission.
 Sources of
Modes of transmission Examples of risk factors Examples of infections
infection
Surgical site infections
& catheter related
Surgery.
Break of natural barriers infections due to
Insertion of peripheral or
Self-infection (skin and mucous Staphylococcus aureus.
central line catheters.
membranes) Urinary tract
Staphylococcus aureus carriage
infections due to
Escherichia coli
Surgical site infections
& catheter related
infections due to
Table 1. Sources of healthcare Via hands of staff
Failing hand hygiene before Staphylococcus aureus
associated infections, modes of and after patient contact Respiratory tract
infections due to RSV
transmission, and associated risk & other respiratory
factors illustrated by examples pathogens
Via instruments & Tuberculosis
Heat-sensitive equipment,
Cross-infection equipment not properly e.g. fibre-optic endoscopes
transmitted by fibre-
from other sterilized optic bronchoscope
patients Insufficient domestic
cleaning leading to Diarrhoea due to
Via the environment
accumulation of pathogens Clostridium difficile
on contact surfaces
Hepatitis B or C
transmitted with
Medication of several
drugs from multi-dose
Via donor blood & drugs patients From the same
vials accidentally
multi-dose vial
contaminated with
blood or body fluids
Health Care Associated Infections: Sources and Routes of Transmission drugs from multi-dose 23
Via donor blood & drugs patients From the same
vials accidentally
Sources of multi-dose vial
Modes of transmission Examples of risk factors contaminated with
Examples of infections
infection blood or body fluids
Surgical site infections
MRSA carriage. Surgical
& catheterwound
related
Surgery.
Break of natural barriers Insufficient handhygiene in infections.
Hand-borne infections due to
Insertion of peripheral
connection with treatment or Catheter related
Self-infection (skin and mucous Staphylococcus aureus.
central line catheters.
and care of patients infections
membranes) Urinary tract
Hospital staff Staphylococcus aureus carriage
infections due to
Puerperal
Escherichiafever
coli &
Carrrier of Streptococcus
surgical
Surgical wound
site infections
Air-borne during surgery pyogenes in the operating
infections
& catheterwith
related
theatre
Streptococcus
infections duepyogenes
to
Aspiration
Failing hand ofhygiene
oral secretions
before Staphylococcus aureus
Via hands of staff
following ingestion
and after patient of tap
contact Respiratory tract
Contact with
water contaminated with Legionella
infections pneumonia
due to RSV
Hospital contaminated tap water
Legionella. & other respiratory
environment Immunosuppression pathogens
Via instruments
Inhalation &from
of dust Rebuilding of hospitals. Tuberculosis
Lung infection due to
Heat-sensitive equipment,
equipment not properly Immunosuppression
Cross-infection buildings transmittedfumigatus
Aspergillus by fibre-
e.g. fibre-optic endoscopes
from other sterilized optic bronchoscope
Table 1. Sources of healthcare associated infections, modes of transmission, and associated
patients Insufficient domestic
risk factors illustrated by examples
 Hands of
health care worker

Fig. 3. Interactions between

health care workers’ hands
and touch sites in the hospital Patient with
environment on transmission contagious organism Susceptible host
e.g. MRSA
of pathogens from one
patient to another.

Touch sites in the

hospital environment

Fig. 3. Interactions between health care workers’ hands and touch sites in the hospital
 Take home messages

• A regular review of HAI surveillance data is critical for

hospitals to identify gaps in prevention and address any
observed increases in HAIs.
• Infection prevention staff should continue to reinforce
infection prevention practices in their facilities, and
• Consider the importance of building resiliency in their
programs to withstand future public health emergencies.