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AUDITING

HOSPITAL ASSOCIATED
INFECTIONS
Dr.T.V.Rao MD

3/6/16

Dr.T.V.Rao MD

NOTE TO READERS
The Present program is made for benefit of many Medical Professionals in many
Universities, medical establishments who teach Infection as a Important topic to
life and survival in Particular the Developing world, as I wish to say there are not
many very accurate methods to identify the true problems in identifying the
Hospital Associated Infection,
Self Audit of many who work with Infection control committee to be the beginning
great success
Life is a matter of learning from many failures when we work with real dedication
No audit is complete without implanting the established standard operative
procedures HOPE NOT FORGETTING THE HAND WASHING
However this file teaches only basics and rest will be your great efforts to save
many with Hospital Associated infections
Dr.T.V.Rao MD
Freelance Clinical Microbiologist
3/6/16

Dr.T.V.Rao MD

What are Hospital Associated


Infections
Hospital-acquired infections (HAIs)
(also called nosocomial infections or
health-care-associated infections)
are infections that a patient acquires
while in hospital being treated for
some other condition. They have a
significant impact on both patients
and the provinces health system
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Dr.T.V.Rao MD

Healthcare-associated Infections
WHAT cdc THINKING

At any given time, about 1 in every 20


patients has an infection related to their
hospital care. Healthcare-associated
infections (HAIs) not only affect patient
lives, but also add to our growing
healthcare costs
CDC has identified eliminating HAIs as a
Winnable Battle. With additional effort and
support for evidence-based, cost-effective
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Dr.T.V.Rao MD

SOURCE OF INFECTION
Exogenous/indirect

Endogenous/dire
ct:
Caused by the
organisms that are
present as part of
normal flora of the
patient
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Caused by organisms acquiring by


exposure to hospital personnel, medical
devices or hospital environment, crossinfection from medical personnel
hospital environment- inanimate objects
air
dust
IV fluids & catheters
washbowls
bedpans
endoscopes
ventilators & respiratory equipment
water, disinfectants etc
Dr.T.V.Rao MD

EXOGENOUS SOURCES OF
INFECTION

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Dr.T.V.Rao MD

infections, and antibiotic resistance


have moved beyond hospitals
Hospital
s
Ambulator
y Facilities

Dialysis
Facilities
Longterm
Care

Impact of Hospital Associated


Infections
The impact of such
infections can range
from longer hospital
stays to more serious
conditions that may
require surgery or
result in negative
long-term health
effects. In severe
cases
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Dr.T.V.Rao MD

Major Types of Nosocomial Infections

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Dr.T.V.Rao MD

Richards, MJ. 1999.


Crit Care Med 27; 887.
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Impact of Hospital
Associated
HAIs can cause
Infections
death. For the

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health-care
system, such
infections
increase
treatment costs
and result in
longer wait times
for a hospital bed

Dr.T.V.Rao MD

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Healthcare-associated Infections (HAIs)


CDC estimates 1 in 25 hospital patients has an infection,
including

Central-line associated bloodstream


infections
Catheter-associated urinary tract infections
Surgical site infections
Pneumonias - ventilator-associated and
others
Clostridium difficile infections
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Dr.T.V.Rao MD

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Superbugs Invade the Patients in


Health care
HAIs occur across
healthcare settings (e.g.,
long-term care, outpatient)
Many infections are caused
by resistant microorganisms
Carbapenem-resistant
Enterobacteriaceae (CRE)
Methicillin-resistant
Staphylococcus aureus
(MRSA)
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Dr.T.V.Rao MD

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Common Hospital Associated


Infections
HAIs such as methicillin-resistant
Staphylococcus aureus (MRSA) and
vancomycin-resistant enterococci (VRE)
are resistant to certain antibiotics.
The incidence of
MRSA has approximately doubled, while
that of VRE have increased.
Increases in antibiotic-resistant
organisms are of concern because they
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Dr.T.V.Rao MD

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Why we need Auditing


The Modern Medicine at Risk
with

Loss of effective
antibiotic treatment
could make routine
infections deadly
Pneumonia
Urinary tract
infections
Wound infections
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Dr.T.V.Rao MD

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Infection control Committee


(ICC):
The hospital ICC is charged with the
responsibility for the planning,
evaluation of evidenced-based
practice and implementation,
prioritization and resource allocation
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Dr.T.V.Rao MD

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Back Bone of Infection Control


Team
Infection Control
Doctor (ICD)

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Infection Control
Nurse (ICN)

Dr.T.V.Rao MD

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The Modern Medicine at Risk with


Patients who receive
specialized care will be at
highest risk
Cancer chemotherapy
Complex surgery
Joint replacements
Organ transplants
Chronic conditions (e.g.,
rheumatoid arthritis)
Dialysis
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Dr.T.V.Rao MD

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TYPES OF INFECTIONS
Urinary tract infections (UTI)
Surgical wound infections (SWI)
Lower respiratory infections
Traumatic wounds and burns infections
Primary bacteremia
Gastrointestinal tract
Central nervous system
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Dr.T.V.Rao MD

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Spread of Hospital Associated


Infections
Some HAIs are infectious diseases that can
spread throughout a hospital .
Each of them can be transmitted
through contact (touching an infected
person or a surface where the bacteria live).
Therefore, handwashing and cleaning and
disinfecting surfaces that patients and
hospital staff come into contact with
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Dr.T.V.Rao MD

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OUR GOALS
Prevention Programs:
Detect, Prevent, Respond

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Surveillance
helps effective documentation
Surveillance is defined as the systematic ongoing collection,
collation, and analysis of data with timely distribution of the
information to those who require it in order to allow action
to be taken where necessary.
INFECTION CONTROL
COMITTE notes that there is conclusive evidence to show
that the establishment of a surveillance system is
associated with reductions in infection rates. Surveillance is
particularly useful in monitoring the effectiveness of
infection prevention- and-control programs. Typically,
trainedinfection-prevention-and-control professionals or
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Dr.T.V.Rao MD

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Surveillance to be done by
Trained Professionals
Typically, trained
infectionprevention-andcontrol
professionals or
hospital
epidemiologists
perform
surveillance of
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Dr.T.V.Rao MD

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Surveillance to be done with


accuracy and accountability
Hospital surveillance
systems should clearly
define all data
elementsthat is, the
specific items that the
system is monitoring
and counting. This
ensures that the
information collected
is consistent, accurate,
and reproducible
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Dr.T.V.Rao MD

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Microbiology Departments
establish a mechanism to inform
the results

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Keep track of the number of laboratory confirmed cases of


C. difficile, MRSA, and VRE. They should analyse the
information gathered on an ongoing basis to determine their
infection rates and identify trends signalling the need for
corrective action, such as staff education or changes in
practice.

Dr.T.V.Rao MD

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All issues to be discussed with


Hospital Infection control committee

Core indicators for


monitoring HAIs
province wide
should be developed
and reported on
frequently. As well,
there should be
regionally coordinated
surveillance of the
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Dr.T.V.Rao MD

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The hands are the most


important
vehicle of transmission of
HCAI

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Matter which can reduce Health


Care associated Infections
Prevention of AR transmission needs to be
across healthcare and community settings
Networks of healthcare facilities in
communities around the country working
together with health departments to:
Better detect and respond to outbreaks
Prevent infections
Improve prescribing Implement Antibiotic
Policy
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Why surveillance?
NCI cause of morbidity and mortality
One third may be preventable

Surveillance = key factor


an infection control measure
overview of the burden and distribution of NCI
allocate preventive resources

Surveillance is cost-efficient!!
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Dr.T.V.Rao MD

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Objectives OF Surveillance
Reducing infection rates
Establishing endemic baseline rates
Identifying outbreaks
Identifying risk factors
Persuading medical personnel
Evaluate control measures
Satisfying regulators
Document quality of care
Compare hospitals NCI rates
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The surveillance
loop
Surveillance centre

Health care
system

Reporting

Data

Action

Information

Analysis,
interpretation

Event

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Feedback,
recommendations
Dr.T.V.Rao MD

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Role of infection control teams


Education and training
Development and
dissemination of
infection control policy
Monitoring and audit
of hygiene
Clinical audit

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Considerations when creating


a surveillance system
Goal of the surveillance system
(why)
Engage the stakeholders (who)
Surveillance method (what, how,
when)
definition
what to collect
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CDCs NHSN Data For Action


Targeted
Assessment For Prevention (TAP)
CDCs NHSN
Data
Over 4,800
hospitals
currently
reporting
CAUTI, CLABSI,
and C. difficile
data
Target

Target hospitals
with highest
number of
CDC funded
health
excess infections

Partnering for
Prevention
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Dr.T.V.Rao MD

departments
AHRQ funded
networks
CMS funded
networks
Other partners

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Targeting
Assessment
Implementation
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Using CDCs NHSN Using CDCs NHSN Data for Action:

Targeted Assessment for Prevention (TAP) StrategyData for


Action:
Targeted Assessment for Prevention (TAP) Strategy
Targeting Assessment Implementation

Identify healthcare facilities with excess infections


Assess gaps in infection prevention in targeted
facilities/units using CDC tools
Implement interventions to address gaps in infection
prevention using CDC Implementation Guidance
Partner among health departments and hospital
networks with CDC and clinical expertise to prevent
infections

Uttermost care should be


taken in following services:
House keeping
Dietary services
Linen and laundry
Central sterile supply department
Nursing care
Waste disposal
Antibiotic policy
Hygiene and sanitation
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Dr.T.V.Rao MD

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Audit Method
Audit Method Select
areas Focus on a few
important ones Report
should include
Description of the
physical layout
Observation of practices
Action taken/Practice
changed Collection of
local audit data
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All The Team Member should


Preparation of Audit
know the purpose
ofstaff
Audit
Team All
must be

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included Need to
understand its purpose
is to improve practice
Not punitive or to
identify weaknesses
Pre-audit meetings
essential Consistence
and anonymity Identify
leaders in the area
Knowledge

Dr.T.V.Rao MD

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The Auditing Infection will have the


following Components
Identify the infection risks
Comprehensive
identification of
'what, where, when,
why and how' in
relation to risks and
potential risks to
the organisation at
all levels is crucial.
Some of these risks
will be immediately
identifiable; others
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Dr.T.V.Rao MD

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Identify the infection risks


An important feature of
this stage is to focus on
the full range of risks
across the organisation's
objectives. Not every risk
will be controlled at an
acceptable level. The risks
should be stated explicitly
and must be
communicated to the
organisation, patients and
public;
and others.
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Dr.T.V.Rao MD
Healthcare Associated

40

ROLE OF DIAGNOSTIC
MICROBIOLOGY
LABORATORY

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Dr.T.V.Rao MD

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Surveillance of Operation
Theaters and Critical care
Areas
Provides environmental
microbiology methods for
measuring contamination
of healthcare
environment includes
1 Settle plates
2 Surveillance of
Operation theaters with
colony counters ( Many
Air Samplers available )
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Dr.T.V.Rao MD

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Documentation of Antibiotic
Resistance Patterns
Develops and
evaluates
methods to
reliably detect
emerging
antimicrobial
resistance
Use WHONET FOR
EFFECTIVE

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Dr.T.V.Rao MD

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Assists in healthcareassociated outbreak


investigations
Hospitals may perform
prevalence surveys to
determine the extent
of MRSA and VRE.
These surveys involve
taking samples from
all patients in specific
units to obtain
laboratory
confirmation of
infection. With the

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Dr.T.V.Rao MD

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Conducts applied research on


improved detection methods for HAIs

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These surveys
generally result
in the hospitals
infection rate
being higher than
it would be
without the
survey data.

Dr.T.V.Rao MD

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Assists in healthcareassociated outbreak


investigations
The ultimate goal is
to have no HAIs, but
the hospitals we
visited indicated
that there may be
no practical way to
achieve this. A more
achievable goal is to
keep HAIs from
exceeding a
targeted maximum

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Dr.T.V.Rao MD

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ROLE OF INFECTION
CONTROL COMITTE

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Dr.T.V.Rao MD

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All Hospitals Implement


Antibiotic Stewardship
Programs

Leadership
commitment
Accountability
Drug expertise
Action
Tracking
Reporting
Education
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Dr.T.V.Rao MD

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Role of infection control teams


Education and
training
Development and
dissemination of
infection control
policy
Monitoring and audit
of hygiene
Clinical audit
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Dr.T.V.Rao MD

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Monitor & Review the Audit


Establish a system
where all risks have
a review process
and defined
reassessment
timetable. This will
ensure that the risk
management
process is dynamic
and continuous. The
review process must
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Monitor & Review the Audit

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All identified risks and associated actions must be monitored


and reviewed on a continuous basis by named individuals
and/or groups, for example, the Infection Control Committee.
A risk control plan that does not change very often may
indicate that risk is being identified, but not managed or
controlled

Dr.T.V.Rao MD

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How Frequently We should Audit


Routine Reports
Weekly reports
Rapid feedback on
incidental issues
Monthly reports
Audit results,
education, training,
and consultations
Quarterly reports
Formal reports
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Dr.T.V.Rao MD

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Try to Develop a Audit calendar

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Data derived from audits used to inform the IP&C program


The intent of audits is to promote good practice, improve
patient care, and ensure safety A key person must be
identified in each area to help facilitate implementation of
any recommendations Auditing is relatively simple, but timeconsuming Important to plan and develop an audit calendar

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HAND WASHING SAVES MANY LIVES


INSPITE OF MANY ADVANCES

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International Federation
of Infection Control IFIC
International Federation of Infection Control IFICs mission is to
facilitate international networking in order to improve the
prevention and control of healthcare associated infections
worldwide. It is an umbrella organisation of societies and
associations of healthcare professionals in infection control and
related fields across the globe. The goal of IFIC is to minimise the
risk of infection within healthcare settings through development of
a network of infection control organisations for communication,
consensus building, education and sharing expertise.

For more
information go to http://theific.org/http://theific.org/
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WASH YOUR HANDS


CREATE SAFE HOSPIALS

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References
Prevention and Control of Hospitalacquired Infections Office of the Auditor
General of Ontario Special Report 2008
Guidelines from Center for Disease Control
CDC Atlanta USA
National Institute of Health NIH USA

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Attention of Viewers
I am thankful to many in the world who made me to achieve my desired goals faster than
I thought, having > 3-5 million health professionals share and utilize my knowledge for the
benefit of mankind, Today I wish to be freelancer to the world to create interest in
Medical, Clinical and Diagnostic Microbiology with more emphasis on Infectious diseases
and Hospital associated Infection wish to be your partner in educating many millions who
know well the importance of Infectious diseases

You can visit many web sites of mine


www.medmicrobes.com
www.slidehsare.com
www.authourstream.com
www,scribd.com
Be a friend on Facebook with tummalapalli venkateswararao access
Raos Microbiology
Raos Infection care
Microbiology connected Travancore Medical College
For any assistance on INFECTION REALTED ISSUES CONTACT ME AT doctortvrao@gmail.com

Mob +91 7204113154


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Program Created by Dr.T.V.Rao MD for


Benefit of Medical and Paramedical
Professionals in the Developing World
Created from World Wide Resources
Email
doctortvrao@gmail.com
3/6/16

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