Name : Dasuni Chandrabhanu

Roll no : 13

Review on Healthcare Associated Infections

Introduction

Healthcare-associated infections (HAI) are commonly defined as infections not present and without
evidence of incubation at the time of admission to any healthcare facility. This particular entity is
also known as nosocomial, hospital-acquired or hospital-onset infections.

Current research evidence

50% reduction in central line-associated bloodstream infections had been observed (CLABSI)
between 2008 and 20141

No significant change of incidence in overall catheter-associated urinary tract infections (CAUTI)

between 2009 and 20141

17% decrease in surgical site infections (SSI) related to the 10 select procedures tracked in previous
reports.17% decrease in abdominal hysterectomy SSI between 2008 and 2014.2% decrease in
colonic surgery SSI between 2008 and 20141

8% reduction in hospital-onset Clostridium difficile infections between 2011 while 13 %decrease in

hospital-onset methicillin-resistant Staphylococcus aureus (MRSA) bacteremia between 2011 and
20141

Identification

Healthcare-associated Infection can occur

up to 48 hours after hospital admission

up to 3 days after discharge

up to 30 days after a surgery

in a healthcare facility when someone was admitted for reasons other than the infection

Symptoms of Healthcare-associated Infections will change according to the type. The most common
types of Healthcare-associated Infections are

Urinary tract infections (UTIs)

Surgical site infections

Gastroenteritis
 Meningitis

Pneumonia

Primary bloodborne infections

Common symptoms for these infections may include:

Wound discharge

fever

cough, shortness of breathing

burning with urination(dysuria) or difficulty urinating

Prevention & control

1. Hand washing

This is the single most important and most effective hygiene practice in terms of
reducing the health care associated infections. Healthcare workers must make sure
that they wash their hands before and after seeing or making any contact with
patients. Hand basins with hot and cold water supplies, non-touch taps with
antisplash equipments, supplies of liquid handwash and disposable paper towels or
disposable clean, cloth towels are recommended to facilitate hand hygiene2.
CDC guidelines and the WHO guidelines recommended that healthcare workers
wash their hands with soap and water when visibly soiled and exposure to potential
spore-forming pathogens is strongly suspected or proven, including outbreaks of C.
difficile3,4. Otherwise, handwashing with an alcohol based susbtance is
recommended for all other occasions, as it is faster, more effective and better
tolerated by the skin. Exposure of hands to body fluid in presence of intact skin, that
should be disinfected but it is particularly vital when skin is not intact or mucous
membrane has been exposed. Compliance monitoring for hand hygiene among
healthcare workers therefore had been given a higher recommendation level4.

2. Usage of gloves

Recommendations for the use of gloves4:

Sterile gloves should be used for procedures requiring a sterile field, involving
normally sterile areas of the body

Non-sterile gloves should be used for procedures other than the above

General purpose gloves should be used for housekeeping and cleaning

Use of gloves had been recommended if there is a risk of being contacted of blood
or other potentially infectious substances with, mucous membranes, or non-intact
skin.
 Recommendations for changing gloves4:

After contact with each patient and when performing separate procedures on the
same patient if cross-contamination is possible , gloves should be changed

Whenever the gloves have been torn or damaged, gloves should be changed

After completion of any procedure not involving patients but requiring the use of
gloves

Before documentation and involving in any hospital work

Remove gloves after caring for a patient. Healthcare workers should not wear the
same pair of gloves for the care of more than one patient.

3. Eye protectors

Eye protectors or goggles are recommended during procedures where there is potential
for splashing, splattering or spraying of blood or other body fluids4.

4. Waste disposal

Waste disposal and spillage should be done according unit disposal policies and protocols.
According to CDC recommendations should be followed differently for general waste,
cytotoxic waste, pharmaceutical waste, chemical waste and radioactive waste4. For blood
spillage in ward or in an operation theatre, cleaning should be done at the earliest with
paper towels followed by water and detergents. Sodium hypochlorite is currently not
recommended for that purpose. Laboratory spillage should be absorbed on to paper towels
and disposed of as clinical waste. The contaminated surfaces should be treated with 2.0-
2.5% sodium hypochlorite, left for 1 h and cleaned again with paper towels that are
disposed of as clinical waste. It has been observed that HBV and HCV in dry blood remain
infectious even when exposed to external environment for up to a week and 16 h
respectively. Recommendations remain the same even if blood is not visible or not present
in sufficient quantity. Glucometers should be cleaned and disinfected as per CDC
recommendation after every use to avoid contamination4.

5. Training of healthcare personnel

Effectiveness of staff education on healthcare-associated infection prevention is

controversial but as a part of comprehensive infection control program its value had been
taken into consideration. Specially-appointed infection control personnel can help in
imparting prescheduled training, maintaining record, monitoring the knowledge base and
bed side application of the knowledge4. Ongoing staff education is also a mandatory need.
Education of healthcare workers will be recommended and periodic assessment of
adherence to insertion and maintenance of intravascular catheters protocol had been given
higher level of recommendation .To prevent airborne transmission negative pressure single
rooms with anterooms and fresh air at 100% (recirculation of air) is recommended to
 achieve most effective dilution of airborne microorganisms. Periodic safety and operational
inspection should be done by administrative authorities

6. Special recommendations for mortuaries and forensic departments are as follows4

Body storage should be done at an internal temperature of 4C

A freezer maintained at 20C should be used for longer-term storage

Mortuary must not be used except storage of bodies

All refrigerators/freezers should be monitored and equipped with alarms that works
24 hours daily

Mortuary should be designed in such way to minimize manual handling of bodies

Specially maintained rooms should be used for postmortems with negative air
pressure ventilation.

7. Vaccination
Following vaccines are recommended by CDC for the healthcare personnel5.
Hepatitis B- Intramuscularly 3 doses
Influenza- Intramuscularly single dose
Varicella/Chickenpox- subcutaneously 2 doses
Meningococcal subcutaneously (specially for microbilogists)

References

1. The National and State Healthcare-Associated Infections Progress Report 2014: Centre for
Disease Control and Prevention. Available from
[https://www.cdc.gov/hai/surveillance/index.html]
2. Boyce JM, Pittet D. Guideline for Hand Hygiene in Health-Care Settings: Recommendations of the
Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA
Hand Hygiene Task Force. Morbid Mortal Wkly Rep. 2002;51:145. [PubMed]
3. WHO guidelines on hand hygiene in health care: A summary. 2014. Mar 10, Available from:
http://www.whqlibdoc.who.int/hq/2009/WHO_IER_PSP_2009.07_eng.pdf .
4. Guideline for isolation precautions: Preventing transmission of infectious agents in healthcare
settings. 2014. Mar 10, Available from:
http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf . [PubMed]
5. Healthcare Personnel Vaccination Recommendations 2017; Immunization Action Coalition Saint
Paul, Minnesota. Available from :www.immunize.org & www.vaccineinformation.org