HEALTH CARE

ASSOCIATED INFECTION
DR. DMITRY YUNAK
DEFINITION
• Healthcare Associated Infection - is an infection contracted during applying of any
kind treatment in medical or surgical conditions.
• Any infection contracted by a patient during receiving of the treatment, or by
medical staff during according of the treatment - is considered to be healthcare
associated infection.
EVOLUTION OF THE DEFINITION

• Purulent complication

• Nosocomial infection

• Healthcare associated infection

STATISTICS
• Usually HAIs occur in patients under medical care. These infections occur worldwide
both in developed and developing countries.
• Nosocomial infections accounts for 7% in developed and 10% in developing
countries(?).
• As these infections occur during hospital stay, they cause prolonged stay, disability,
and economic burden.
STATISTICS
• Frequently prevalent infections include central line-associated bloodstream
infections (CLABSI), catheter-associated urinary tract infections (CAUTI), surgical
site infections (SSI) and ventilator-associated pneumonia (VAP).
• Nosocomial pathogens include bacteria, viruses and fungal parasites. According to
WHO estimates, approximately 15% of all hospitalized patients suffer from these
infections.
• During hospitalization, patient is exposed to pathogens through different sources
environment, healthcare staff, and other infected patients. Transmission of these
infections should be restricted for prevention.
STATISTICS
• Hospital waste serves as potential source of pathogens and about 20%–25% of
hospital waste is termed as hazardous.
• Nosocomial infections can be controlled by practicing infection control programs,
keep check on antimicrobial use and its resistance, adopting antibiotic control policy.
• Efficient surveillance system can play its part at national and international level.
Efforts are required by all stakeholders to prevent and control nosocomial
infections.
 INCIDENCE IN DIFFERENT WARDS
# Ward %
• Burn ward 1st place Burn ward 10-80%
• Intensive Care Unit (ICU)
2nd place ICU 15-30%
• Dressing (treatment) room
3rd place Dressing room 10-15%
• Surgical ward
4th place Surgical ward 5-10%
 ETIOLOGICAL AGENTS
35%

30%

25%

20%

15%

10%

5%

0%
S.aureus CoNS* E.coli P.aeruginosa Acinetobacter baumannii
2009 2010 2011

* Coagulase-Negative Staphylococci
STAPHYLOCOCCUS AUREUS
• Staphylococcus aureus is a gram-positive, round-shaped bacterium that is a
member of the Firmicutes, and it is an usual member of the microbiota of the body,
frequently found in the upper respiratory tract and on the skin.
• It is often positive for catalase and nitrate reduction and is a facultative
anaerobe that can grow without the need for oxygen. Although S. aureus usually acts
as a commensal of the human microbiota it can also become an opportunistic
pathogen, being a common cause of skin infections including abscesses, respiratory
infections such as sinusitis, and food poisoning.
• S. aureus
ACINETOBACTER BAUMANNII
• Acinetobacter baumannii is a typically short, almost round, rod-shaped
(coccobacillus) Gram-negative bacterium. It can be an opportunistic pathogen in
humans, affecting people with compromised immune systems, and is becoming
increasingly important as a hospital-derived (nosocomial) infection. While other
species of the genus Acinetobacter are often found in soilsamples (leading to the
common misconception that A. baumannii is a soil organism, too), it is almost
exclusively isolated from hospital environments. Although occasionally it has been
found in environmental soil and water samples, its natural habitat is still not known.
• A. baumannii
PSEUDOMONAS AERUGINOSA
• Pseudomonas aeruginosa is a common Gram-negative, rod-shaped bacterium. A
species of considerable medical importance, P. aeruginosa is a multidrug
resistant pathogen recognized for its ubiquity, its intrinsically advanced antibiotic
resistance mechanisms, and its association with serious illnesses – hospital-acquired
infections such as ventilator-associated pneumonia and various sepsis syndromes.
• The organism is considered opportunistic insofar as serious infection often occurs
during existing diseases or conditions – most notably cystic fibrosis and traumatic
burns. It generally affects the immunocompromised but can also infect the
immunocompetent as in hot tub folliculitis. Treatment of P. aeruginosa infections can
be difficult due to its natural resistance to antibiotics. When more advanced
antibiotic drug regimens are needed adverse effects may result.
• P. aeruginosa
BREAK
NOSOLOGICAL
FORMS
 CATHETER ASSOCIATED URINARY TRACT
INFECTION
• Approximately 12%-16% of adult hospital inpatients will have an
indwelling urinary catheter at some time during their hospitalization,
and each day the indwelling urinary catheter remains, a patient has a
3%-7% increased risk of acquiring a catheter-associated urinary tract
infection (CAUTI).
• CAUTI can lead to such complications as prostatitis, epididymitis, and
orchitis in males, and cystitis, pyelonephritis, gram-negative
bacteremia, endocarditis, vertebral osteomyelitis, septic arthritis,
endophthalmitis, and meningitis in patients.
• Complications associated with CAUTI cause discomfort to the patient,
prolonged hospital stay, and increased cost and mortality. It has been
estimated that each year, more than 13,000 deaths are associated with
UTIs.
 CENTRAL LINE ASSOCIATED BLOODSTREAM
INFECTIONS
CLABSIs lead to prolonged hospital stays and increase
health care costs and mortality. An estimated 250,000
bloodstream infections occur annually, and most are related
to the presence of intravascular devices. In the United States,
the CLABSI rate in intensive care units (ICU) is estimated to
be 0.8 per 1000 central line days. International Nosocomial
Infection Control Consortium (INICC) surveillance reported
a CLABSI rate of 4.1 per 1000 central line days. Many central
lines are found outside the ICUs. In one study, 55% of ICU
patients and 24% of non-ICU patients had central lines.
However, as more patients are located outside of the ICU,
70% of hospitalized patients with central venous catheters
were outside the ICU. CLABSI rates outside ICUs are
assumed to be similar to those within ICUs.
 VENTILATOR-ASSOCIATED PNEUMONIA

• Ventilator-associated pneumonia (VAP) is pneumonia that

develops 48 hours or longer after mechanical ventilation is
given by means of an endotracheal tube or tracheostomy.

• VAP results from the invasion of the lower respiratory tract and
lung parenchyma by microorganisms. Intubation compromises
the integrity of the oropharynx and trachea and allows oral and
gastric secretions to enter the lower airways.
 SURGICAL SITE INFECTION

An SSI typically occurs within 30 days after surgery. The CDC

describes 3 types of surgical site infections:
• Superficial incisional SSI. This infection occurs just in the area of
the skin where the incision was made.
• Deep incisional SSI. This infection occurs beneath the incision area
in muscle and the tissues surrounding the muscles.
• Organ or space SSI. This type of infection can be in any area of the
body other than skin, muscle, and surrounding tissue that was
involved in the surgery. This includes a body organ or a space
between organs.
 THE MAIN REASONS OF HAI

• Skin/mucous lesions
• Invasive procedures
• Lack of hygiene
• Antibiotic usage (MDR, XDR, PDR)
• Disinfection substances
ANTIBACTERIAL
RESISTANCE
MDR/XDR/PDR
KINDS OF ANTIBACTERIAL RESISTANCE
• MDR – Multidrug-resistance – was defined as acquired nonsusceptibility to at least
one agent in three or more antimicrobial categories.
• XDR – Extensively drug-resistance – was defined as nonsusceptibility to at least one
agent in all but two or fewer antimicrobial categories (i.e. bacterial isolates remain
susceptible to only one or two categories).
• PDR – Pan drug-resistance – was defined as non-susceptibility to all agents in all
antimicrobial categories.
REASONS OF MDR APPEARANCE
• Large antibiotic usage
• Unjustified antibiotic usage
• Abandoned treatment
• Wrong antibiotic dosage
MECHANISM OF RESISTANCE
• The absence of the structure, which can be damaged by the antibiotic;
• The presence of an extra defense lair;
• Ability of the bacteria to neutralize the antibiotic;
• As a result of genetic mutations (metabolism of the bacteria is modified in such way,
that the action of changes produced by the antibiotic are not that critical for the
bacteria anymore).
THE END