Health care facilities based infections

Dr. Ardini S Raksanagara,dr.,MPH. Public Health Department Faculty of Medicine

SPECIFIC LEARNING OBJECTIVES

The student will be able : to illustrate safety hazards in the health care facilities (C3)
Define the nosocomial infections Describe the source of Nosocomial infections Describe the transmission of Nosocomial infections Describe the standards precaution in infection control practices Describe the additional precaution in infection control practices To explain that health care workers are at risk of acquiring infection through occupational exposure

Sub topics :
Health and Safety Hazards in the Health Care Facilities Definition Source Transmission Precaution in infection control practices Care of health care workers

References
Depkes RI: Pedoman Pengendalian Nosokomial di Rumah Sakit,2001 Bennet,Brachman ed., Hospital Infections,Little Brown,1992 WHO, Practical guidelines for infection control in health care facilities, 2003

 Human diseases caused by work associated exposure to microbial agents are called occupational infections Exposure occurs among health care workers in hospitals and laboratories

 Occupational infection can occur following contact with infected persons, as in the case of health care workers
Infected with human tissue, secretion or excretion

 US : more than 10 % of workers are health care workers Hazards facing health care include :
Biological hazards contact with infectious agent Chemical hazards Physical hazards Safety and ergonomic hazards Violence Psychosocial and organizational factors : stress, shift work

Health care and clinical laboratory

Increased risk of infection by organism whose natural hosts are humans, as in the case of hepatitis, rubella, AIDS, TBC and staphylococcal disease Some infections may be transmitted through close personal contact with infected patients Direct contact with the organism in culture or in human tissue

Hazards in Health Care

Hazards
Biological

Example
Viral ( hepatitis B, C), HIV, AIDS Bacteria : M. TBC Ethylene oxide, Formaldehyde, Antineoplastic drugs, Waste anesthetic gases Mercury Patient handling, static postures Ionizing radiation, Lasers Violence threat, restructuring, work stress Shift work

Chemical

Physical

Psychosocial

1. Definition Nosocomial
Nosocomial infections : Are infections that develop within a hospital , or Are produced by microorganism acquired during hospitalization

The risk of nosocomial infections

Hospitalized patients Workers involved in their care
The risk of infection :
Renal dialysis Laboratories Nursing home Institution for retarded prisons

Nosocomial infections : May involve not only patients but also anyone else who has contact with a hospital, including ; - members of staff - volunteers - visitors - workers - salesperson - delivery person

 The majority of nosocomial infections become clinically apparent while the patients are still hospitalized; However, the onset of disease can occur after patient has been discharged Hepatitis B is an example of nosocomial disease with a long incubation period; its clinically onset usually occurs long after the patient is discharged from the hospital

Type of nosocomial diseases

1. Preventable infection hand washing can prevent infection gram negative organism from the urinary collection + 30 % 2. Nonpreventable infection is one that will occur despite all possible precaution exp. Infection in an immunosuppresed patient due to his or her own flora

2. Source
Organism that cause nosocomial infections come from Endogenous (Autogenous) Exogenous

1. Endogenous infections Are caused by the patients own flora Organism are brought into the hospital by a patient 2. Exogenous infections Result from transmission of organism from a source other than patient

The characteristic of a nosocomial disease

1 2 3 Sporadic Endemic Hyperendemic
That cases occur occasionally an irregularly, without any specific patterns the disease occurs with ongoing frequency in a specific geographic area in a finite population and over a defined time period The disease refers to what appears to be a gradual increase in the occurrence of a disease in a defined area beyond the expected number of cases Is a definite increase in the incidence of a disease above its expected endemic occurrence Is used interchangeably with epidemic - An increased rate occurrence but not at levels as serious as an epidemic

4 5

Epidemic Outbreak

3. Transmission CHAIN OF INFECTION

Infections results from the interaction between an infection agent and a susceptible host This interaction called transmission means contact between the agent and host The chain reaction three interrelated factors

The agent

Transmission

The host

Agents
The majority of nosocomial infection problems caused by bacteria and viruses

Transmission
Describes the movement of organism from the source to the house

Types of transmission
1. Contact spread disease 1. direct contact 2. indirect contact 2. Common-vehicle spread 3. Air borne spread 4. Vector borne spread

HOST
The third link in the chain of infections
Disease does not always follow the transmission of infection agents to a host
Various agent factors A variety of host factors

Host factors that influence the development of infections are

The site of deposition of the agent The host defense mechanism

Entrance (port d entry)

Sites of deposition
Skin Mucous membrane Respiratory Gastrointestestinal Urinary Tract

Entrance (port d entry)

NO Entrance 1 Skin

Disease/Agent
Leptospirosis, Staphylococcus, HIV, Hepatitis B, Pseudomonas Aeroginosa Tuberculosis E. Coli, Shigella, Staphylococci Rubella, Toxoplasmosis

2 3 4

Respiratory tract Intestinal Tract Placenta

Urinary Tract

Cytomegalovirus (renal transplantation)

4. Precaution in infection control practices

Infection control practices (WHO) : Purpose : to provide comprehensive information to health care workers in the prevention and control of transmissible infections Objective : to provide administrator and health care workers with the tools to enable them to implement the infection control program effectively in order to protect themselves and others from the transmission of infections

Infection Control Program : For reducing the risk of health care associated or nosocomial infections Risk prevention program for patients and staff

Infections Control Practices

Infection control practices can be grouped in two categories 1. Standard precaution 2. Additional (transmission based) precaution

Standard precautions
Require that health care workers assume that the blood and body substances all patients are potential sources of infection, regardless of the diagnosis, or presumed infectious status
Additional precaution Are needed for disease transmitted by air, droplets and contact.

Standard precautions
Treating all patients in the health care facility with the same basic level of standard precautions involves work practices that are essential to provide a high level of protection to patients, health care workers and visitors

Standard precautions
These include the following : 1. Hand washing and antiseptic (hand hygiene) 2. Use of personal protective equipment when handling blood, body substances, excretions and secretions 3. Appropriate handling of patient care equipment and soiled linen 4. Prevention of needle stick/sharp injuries 5. Environmental cleaning and spills management 6. Appropriate handling of waste

Additional (Transmission Based) Precautions

Are taken while still ensuring standard precautions are maintained Additional precautions include :
1. airborne precautions 2. droplet precautions 3. contact precautions

Disease which are transmitted by this route airborne TB, measles, chicken pox, pulmonary Precautions plaque
(droplet <5 micron)

droplet Pneumonias, pertusis, diphteria, influenza Precautions type B, mumps, meningitis

(droplet >5 micron)

contact Infection with multiple antibiotic resistant precautions organism, enteric infections, skin infections

Exp. - Place patient in a single room - Wear protective equipment : mask, gloves, gown

5. Care of health care workers

Health care workers are at risk of acquiring infection through occupational exposure Hospital employees transmit infections to patients and other employee Immunization recommended for staff - hepatitis A and B - rubella - influenza - tetanus - measles - diphteria

Occupational pulmonary Tuberculosis

Common occupational infection resulting from repeated close contact with infected patients Staff laboratory 100 and 200 times more likely than general public to develop TBC Health care workers in TBC treatment centers, in laboratory and in veterinary clinics are particularly affected

TBC
Is caused by Mycobacterium tuberculosis Is transmitted occupationally by droplet infection, contact with infected material from humans (sputum) or animals Infectious patients disseminate the organism when coughing, sneezing, talking

 Tubercle bacilli may be presents in

Gastric fluid Cerebrospinal fluid Urine Sputum Tissue specimens active lessions

Control and prevention

Pre placement examination Test tuberculin Vaccinated with BCG if tuberculin test Periodic X-ray Health education Proper disposal of infected material should be observed

Viral Hepatitis B and C

The most frequently occurring work related infectious disease in US Health care workers at great risk of infection contact with blood and body fluids of infected persons The disease may pass into chronic active hepatitis : liver cirrhosis, hepatic failure and liver carcinoma Exposure to patients body fluids via contaminated glassware and other contaminated equipment exp. Needles Potential risk procedure : phlebotomy, dentistry,

 The route of transmission for Hepatitis B is through body substances :

Blood and blood product Saliva Cerebrospinal fluid Peritoneal Pleural fluid Pericardial fluid Synovial fluid Amniotic fluid Semen Vaginal secretion Other body fluid containing blood

Prevention hepatitis B immunization

Prevention of Hep.B Infection

High risk screened for HBs Ag Immunization Hepatitis B vaccine Employee education Appropriate sterilization and disinfection procedure
Reusable equipment should be autoclaved Disposable material should be disposed of in appropriate containers

Use protective clothing and gloves Minimize the contact with patient

Hepatitis A
Is a risk for health care institution for the retarded where personal hygiene is poor Virus is mainly transmitted by the fecal oral route Careful hand washing by health care personnel is the most important measure for preventing

Exposure To Human Immunodeficiency virus (HIV)

The route of transmission for HIV is person to person via sexual contact, sharing of needles contaminated with HIV, infusions that are contaminated with HIV, transplantation of organs or tissues that are infected with HIV. Risk reduction standard precautions using personal protective equipment, appropriate use of safety devices, a needle disposal system

 Health care workers are at risk of acquiring HIV via exposure to patients infected blood or body fluid The greatest risk to medical personnel is percutaneous exposure needle stick injury

Prevention
Avoid contact with potentially infected blood, plasma or secretion Hands or skin should be washed immediately and carefully if blood contact occurs Mucous membrane, including the eyes and mouth should be protected Contaminated surfaces should be disinfected with 5 % sodium hypochlorite. Aseptic technique and sterilization Health education concerning transmission of blood borne infections

Sharp injuries Meningococcal meningitis SARS Varicella, Influenza, Pertusiss, Diphteria, Rabies