HOSPITAL ACQUIRED INFECTION (HAI)

Definition :-

HAI is defined as any clinically recognizable disease that

affects a patient as a consequence of his or admission into

the hospital or attending for treatment or from the hospital

staff as a consequence of their work whether or not the

symptoms appear by the individual in the hospital or after

discharge.

Hospital acquired infections are also called as nosocomial infections.

Nosocomial infections can occur as result of

therapuetic manifestations by the hospital staff, such physician induced infections are

called as iatrogenic infections.

History :1.JOSEPH LISTER (1827 1912) Antiseptic era

British surgeon and medical scientist pioneer of antibiotics

Used carbolic acid To prevent surgical infection 2.IGNAZ SEMMELWEIS (1861) Prevention of puerperal fever by simple hand washing

3.FLORENCE NIGHTINGALE (1820 1910)

Soap, water,cleanliness 4.Von BERGMANN (1873) Introduced wearing gloves,

1940 Begining of antibiotic era by the invention of penicillin

Transmission of HAI :Hospital factors :-

1. low resistance of patients to infection.

2. Contact with infectious persons

3. Contaminated environmental sites

4. Drug resistance of endemic microbes. 5.Sophisticated medical technologies enhance the risk of infection

Organism responsible for HAI (bacteria) Gram positive cocci staph. aureus Gram negative bacilli Pseudomonas

Group A streptococci
Group B streptococci Anaerobic cocci

Salmonella
Shigella E.coli

Anaerobic bacilli Clostridia

Klebsiella
Proteus

Viruses Hepatitis Chicken pox Influenza and RSV

CMV
Measles

Rubella
Rota virus

Fungi
Candida

Histoplasma
Coccidioides

parasite
Pneumocystis,

Toxoplasma

Sources :1.Endogenous source :From the patients own normal flora

2.Exogenous source :1. From another person in the hospital 2. From an inanimate object

Routes of transmission :Route Source 1. Aerial (From person) Droplets Mouth Nose Skin scales Skin exudates Infected lesion

Examples of disease

Measles, tuberculosis, Pneumonia Staphylococcal sepsis

Staphylococcal Streptococcal sepsis

Community acquired pneumonia

2. Aerial (from inanimate source) particles Respiratory Gram negative equipment respiratory infection A.C Legionnaires disease

Fungal infections

3. contact (from persons) Direct Respiratory secretions Indirect via equipment Feaces , Urine. Skin & wounds

Staphylococcal & Streptococcal sepsis

Diarrhea and Pseudomonas sepsis.

4. Contact (Environment) Equipment , food , medicaments , fluids 5. Inoculation Sharp injury Blood products Enterobacterial sepsis Pseudomonas

Hepatitis B , HIV

Host factors : Age Sex Heredity Underlying disease Nutritional status Immune status

Immunization status

 Diagnostic and therapeutic procedures

Treatment with antibiotics Trauma Congenital abnormalities Foreign bodies Clothes , emboli and Neoplasia

Types of HAI 1.Urinary tract infections 2.Lower respiratory tract infections

3.Surgical wound infections

4.Gastrointestinal disease 5.Bacteremia & Septicaemia 6.Viral infections 7.Fungal & parasitic infections.

Diagnosis of HAI
Routine bacteriological method Sampling from sources of infections like hospital personell,inanimate objects, water,air or food. Typing of isolate Following strict quality control measures

Prevention of HAI:-

1. Designing & equipping hospital building

2. Safe procedures :Hand washing Sterilization & disinfection.

3. Designing of safe procedures specific for operation theatres.

4. Specific ward procedures & isolation of patients who are hazardous.

5. Precautions in laundry service.

6. Infection control measures in dietary department.

7. Hospital waste disposal

8.Infection control policy in blood bank 9.Precautions in health care personal 10.Antibiotic policy. 11.Hepatitis & HIV related policies

12.In service training & education

13.Infection control teams,consisting of

microbiologists,medical,nursing and hospital

administrators.