PRIMUM NON NOCERE

HOSPITAL
INFECTION
CONTROL
Dr A Prakash
Sr Professor, Health Management
National Academy of Indian Railways
Vadodara

Community Acquired Infection

Nosocomial Infection

DEFINITION
An infection acquired in hospital by a patient who
was admitted for a reason other than that infection
and/or
An infection occuring in a patient in a hospital in
whom the infection was not present or incubating
at the time of admission.
This includes infections that are acquired in hospital but
appear only after discharge as well as occupational
infections among health care staff

Historically the focus has been on post operative

infections.
Now serious illnesses like
HIV, Hepatitis B,C & D
The focus has changed
Protection of health care workers & community
equally important

HOSPITAL INFECTION LEADS TO

Patient suffering

Prolonged stay

Permanent disability

Death

Increased cost of health care

INCIDENCE

5% - 15% of Indoor admissions in developed

countries. 9% - 37% of ICU admissions

1/3 are fully preventable

England 100,000 cases causing 5000 deaths

USA 4.5% causing 100,000 deaths

Developing countries no data ?15.5% of

admissions & 5.6/100 surgical procedures
Cost to US $ 6.5 billion in 2004. (Rs 36738
crore)

FACTORS INFLUENCING

The Microbial Agent

Patient Susceptibility

Environmental Factors

TRANSMISSION

Enodogenous 50%

Exogenous 50%

Organisms responsible for HAI are resistant to

common antibiotics

COSTS

Surgical Site Infection or Ventilator Associated

Pneumonia $ 5,500 (>Rs 3,00,000)
MSRA ($ 38,000 > Rs 21,00,000)
UK each 1 spent on alcohol hand wash
saves 10-20.

Main Culprits

Catheter Induced Urinary Infection

Blood Vessel Access Site Infection

Surgical Site Infection

Ventilator Associated Pneumonia

Septicemia

CRITERIA

SSI Any purulent discharge, abscess or

spreading cellulitis at surgical site in one month
UTI Positive urine culture with atleast 100000
bacteria/ml with or without symptoms
Respiratory Symptoms with atleast two of
cough, purulent sputum or X ray infilterates
Vascular Inflamation, lymphangitis or pus
Septicemia Fever/Rigours with atleast one
positive blood culture

CONSEQUENCES

Emotional

Pain & Discomfort

Delayed Discharge

Use of Scarce Resources

Cost

DELAYED DISCHARGE

Urinary Infection 1 to 4 days

S. S. I. - 7 to 8 days

Septicemia 7 to 21 days

Pneumonia 7 to 30 days

FIVE KEY INTERVENTIONS

Hand Hygiene
Decontamination of Treatment Environment &
Equipment
Active Survillance of Cultures
Contact Precautions for Infected & Colonized
Patients
Compliance with Protocols for Central Venous
Catheters & Ventilators

Dirty
Clean
Sterile
Know and keep seperate

Universal Precautions
Standard Precautions
Transmission Based Precautions
Direct
Indirect

Contact
Droplet
Airborn

Single Use Devices

HAND HYGIENE - WHEN

Before touching a patient

Before clean/aseptic procedures

After body fluid exposure risk

After touching a patient

After touching a patient's surroundings

HAND RUBBING
vs
HAND WASHING

HAND WASHING - WHEN

Start of day
Whenever visibly dirty or soiled with blood/body
fluid

After using toilet

Exposure to potential spore forming pathogens

HOT AIR DRYER

Paper Towel

- 48.4%

Hot Air Dryer

+ 254.5%

Paper Towel
24%

Hot Air Dryer

+ 117%

USE OF GLOVES

Sterile Gloves

Clean Gloves

Surgical procedure, Vaginal delivery,Invasive

radiology, Vascular access, Preparing TPN/Chemo
Potential for touching blood, body fluid, secretion,
excretion or items soiled by them, Contact with
mucus membrane/non intact skin, Presence of
highly infectous organism/epidemic, IV insertion/
removal, Suctioning, P/V, P/R

Not Indicated

The use of gloves does not replace the need of

hand hygiene

Management of Sharps

VACCINATIONS
Hepatitis B;
Influenza;
Measles, Mumps and Rubella;
Tetanus,
Diphtheria,
Pertussis;
N. Meningitidis;
Varicella

Hospital Waste Management

Hospital Infection Control Program

Infection Control Nurse
Infection Control Committee
Infection Control Protocol

SUMMERY

Vaccination

Cleaning, Disinfection, Sterilization

Personal Protective Equipment

Post-exposure Prophylaxis

Surveillance

Isolation

Outbreak Investigation

Best of Luck