Health care-associated

infections
Dr Hanan ALGheryafi
Pediatric consultant infectious disease
QCH
 INTRODUCTION
The rapid emergence of resistant bacteria is occurring

worldwide,
The antibiotic resistance crisis has been attributed to the

overuse and misuse of these medications,

as well as a lack of new drug development by the

pharmaceutical industry due to reduced economic incentives

and challenging regulatory requirements.
The Centers for Disease Control and Prevention (CDC) has

classified a number of bacteria as presenting urgent,

serious, and concerning threats, many of which are already
responsible for placing a substantial clinical and financial
burden on the U.S. health care system, patients, and their
Introduction

HCAI is a major problem for patient safety and

its prevention must be a first priority for
settings and institutions committed to
making health care safer.
 Annual financial losses due to health care-
associated infections are also significant

they are estimated at approximately 7

billion in Europe, including direct costs only.

and reflecting 16 million extra days of

hospital stay, and at about US$ 6.5 billion in
the USA.
The impact of HCAI
implies prolonged hospital stay,
long term disability,
increased resistance of microorganisms to

antimicrobials,
massive additional financial burdens,
an excess of deaths
stress for patients and their families
 The most frequent type of infection hospital
wide is urinary tract infection (36%), followed
by surgical site infection (20%), and
bloodstream infection and pneumonia (both
11%).
 Device-associated infection rates reported
from multicentre studies conducted in adult
and paediatric ICUs are also several times
higher in developing countries as compared
to the NHSN system (USA) rates
Neonatal infections are reported to be 320
times higher among hospital-born babies in
developing as compared to developed
countries.
 In developed countries, HCAI concerns 515%
of hospitalized patients and can affect 937%
of those admitted to intensive care units
(ICUs),
 The risk for patients to develop surgical site
infection (SSI), the most frequently surveyed
type of HCAI in developing countries, is
significantly higher than in developed
countries (e.g. 30.9%)
 numerous unafavourable factors such as
understaffing, poor hygiene and sanitation,
lack or shortage of basic equipment,
inadequate structures and overcrowding,

almost all of which can be attributed HAI

Risk of acquiring HCAI

Depends on factors related to :

the infectious agent (e.g virulence, capacity to

survive in the environment, antimicrobial resistance),
the host (e.g. advanced age, low birth weight
underlying diseases, state of debilitation,
immunosuppression ,malnutrition)
the environment (e.g. ICU admission, prolonged

hospitalization,
invasive devices and procedures,

antimicrobial therapy).
 In ICU settings particularly, the use of various
invasive devices
(e.g. central venous catheter, mechanical
ventilation or urinary catheter) is one of the
most important risk factors for
acquiring HCAI.
 CENTRAL LINE
35

30

25

20

CENTRAL LINE
15

10

0
I I I II B
AM AR BI BII A A JA AN AN AL D
A
IJJ
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1
RR
F A D D A B D W H H ra F I
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uh
r SA RA
B
UH JU
M M SH
M SH Q
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m
D
QATIF CENTRAL HOSPITAL
HAIs Rate
From Muhrram 1433- Rabia 1434

VAP
40

35

30

25

20
VAP
15

10

0
I I I II B
AM AR BI BI
I A JA AN AN AL D
A
IJJ
A M AR 1
RR
F A A D D
A A B D W H H RA F BI
A
SA R R A A R AB A W U L R SA A
UH JU
M M SH
M SH Q
U-
A UH R
M JU RA U- D M
D
Over rate in RABI 1

RTI ------37.3%

UTI -----21.3% HAIs =6.3%

BLOOD -----19%

SSI ----- 8.9%

NSSI------ 3.3%

Bedsore------- 5.6%
 Transmission occurs mostly
via large droplets,
direct contact with infectious material or
through contact with inanimate objects
contaminated by infectious material.
Performance of high-risk patient care
procedures and inadequate infection control
practices contribute to the risk. Transmission of
other viral (e.g. human immunodeficiency virus
(HIV), hepatitis B) and bacterial illnesses including
tuberculosis to HCWs is also well known.
 Touch surfaces commonly found in hospital
rooms, such as bed rails, call buttons, touch
plates, chairs, door handles, light switches,
grab rails, intravenous poles, dispensers
(alcohol gel, paper towel, soap), dressing
trolleys, and counter and table tops are
known to be contaminated with bacteria.
COMMONLY CONTAMINATED
SURFACES
Survival Of Pathogens On Surfaces
Organism Survival period

Clostridium difficile (spores) 35->200 days.6,7

Methicillin resistant Staphylococcus aureus (MRSA) 7->300 days.1,4,6,9

Vancomycin-resistant enterococcus (VRE) 5->1400 days.2,3,6,12

Escherichia coli 1.5 hr- 480 days.6,8

Acinetobacter 3->300 days.6,10

Klebsiella 2hr->900 days.5,6

Salmonella typhimurium 10 days- 4.2 years.6

Candida albicans 1-120 days.6

Most viruses from the respiratory tract (eg: corona, Up to 90 days.6

coxsackie, influenza, SARS, rhino virus)

Viruses from the gastrointestinal tract (eg: Up to 90 days.6

astrovirus, HAV, polio- or rota virus)
.Beard-Pegler et al. J Med Microbiol 1988;26:251-5. 1 .Otter & French. J Clin Microbiol 2009;47:205-7. 7
Norovirus (and feline calicivirus)
Bonilla et al. Infect Cont Hosp Epidemiol 1996;17:770-2. 2 8 hr-> . 14
Smithdays.
11
et al. J Med 1996;27: 293-302. 8
.Boyce. J Hosp Infect 2007;65:50-4. 3 . Wagenvoort et al. J Hosp Infect 2000;45:231-4. 9
Blood-borne viruses (eg: HBV or HIV)
.Duckworth & Jordens. J Med Microbiol 1990;32:195-200. 4
Up. Doultree
to >7et al. days.
.Wagenvoort & Joosten. J Hosp Infect
4 2002;52:226-7. 10
J Hosp Infect 1999;41:51-7. 11
. French et al. 2004. ICAAC. 5
.Kramer et al. BMC Infect Dis 2006;6:130. 6 .Wagenvoort et al. J Hosp Infect 2011;77:282-3. 12

33
 Micro-organisms are known to survive on
inanimate touch surfaces for extended
periods of time.
Surface survival
Transmission of health care-associated
pathogens through hands
Transmission through contaminated
HCWshands is the most common pattern in
most settings and require five sequential
steps:
(i) organisms are present on the patients
skin, or have been shed onto inanimate
objects immediately surrounding the patient;
 (ii) organisms must be transferred to the
hands of HCWs;
(iii) organisms must be capable of surviving
for at least several minutes on HCWs hands.
(iv) hand washing or hand antisepsis by the
HCWs must be inadequate or omitted
entirely, or the agent used for hand hygiene
inappropriate.
 (v) the contaminated hand or hands
of the caregiver must come into direct
contact with another patient or with an
inanimate object that will come into direct
contact with the patient.
Prevention
Successful control of MDROs has been
documented in the United States using a
variety of combined interventions:.
These include improvements in hand hygiene
enhanced environmental cleaning
use of Contact Precautions until patients are

culture-negative for a target MDRO.

active surveillance cultures (ASC), education
improvements in hand
hygiene
ISOLATION
enhanced environmental cleaning
enhanced environmental cleaning
Surveillance system had a positive impact on
reducing HAI rates in hospitals
THANK YOU