Health Care Acquired Infections (HCAI)
Infection prevention control is a relevant subject because of the phenomena of healthcare
acquired infections
Healthcare acquired infections a common adverse event in delivery of healthcare services
leading to poor quality of healthcare delivery, increased morbidity, mortality an economic
hardship
HCAls infections that patients acquire while receiving health care
There are infections that first appear 48 hours more after hospitalization or within 30 days after
having received health care
Healthcare associated infections are not present and without evidence of incubation at the time of
admission to a healthcare setting
Risk of HCAl is universal and pervades every healthcare facility and system globally
CAUSES OF HCAI
HCAI may be caused by infectious agents from endogenous or exogenous sources.
Endogenous sources:
Buddy sites such as the skin, nose, mouth, GIT, Vagina that are colonized by local microbial
flora
Exogenous sources:
external to the patients such as healthcare workers, visitors, patient care equipment, medical
devices, or the healthcare environment
CLASSIFICATION OF HCAI
Site Of Infection:
example (surgical site infection, urinary tract infection, central line assisted bloodstream
infection, ventilator associated pneumonia)
Source Of the Infectious Agent:
endogenous / exogenous
By the causative Organism
The prevalence and incidence of HCAl is difficult to ascertain
In a report by the WHO Between 1995 and 2010, the incidents of HCAls Range between 7 and
9% in high income countries as compared to between 7 to 17% in low and middle-income
countries
Surgical site infection is the most frequent HAI worldwide
Many low and middle-income countries do not have a functioning HCAI national surveillance
system
Other risk factors associated with healthcare acquired infections include age of the patient,
immune status come on place of care, and the use of medical devices
HCAIs can occur both as part of an endemic trend within a healthcare facility or as epidemic
situations
• In endemic situations, the occurrence of outbreaks in a healthcare setting are important
indicators of the quality and safety of patient care
• Therefore, surveillance is at the heart of infection prevention and control in healthcare delivery
facilities. Surveillance activities are an essential tool to reduce health care system and infections
as an important first step in identifying problems and priorities
HCAls can occur both as part of an endemic trend within a healthcare facility or as epidemic
situations
• In endemic situations, the occurrence of outbreaks in a healthcare setting are important
indicators of the quality and safety of patient care
• Therefore, surveillance is at the heart of infection prevention and control in healthcare delivery
facilities.
Surveillance activities are an essential tool to reduce health care system and infections as an
important first step in identifying problems and priorities
• In establishing A surveillance system, it is important to have standardized definitions to ensure
reliability and comparability of data
• HCAI surveillance is also challenging because it requires expertise to assess the quality of the
information produced and to interpret its meaning and root cause in order to tailor intervention
measures
STEPS OF HCAI SURVEILLANCE SYSTEM
Planning:
assessment of available expertise, facilities and resources, identification of specific
objectives scope and methods according to the local reality and selection of standardized
definitions and preparation of surveillance protocols
Implementation:
this includes collection of clinical data and other investigations, completion and
finalization of data collection, ongoing laboratory surveillance of sentinel
microorganisms
Analysis and feedback:
data analysis and interpretation and local feedback adapted to the most appropriate means
Interventions driven by surveillance:
identification of appropriate and physical interventions and priority areas according to the
specific results of surveillance a repetition of surveillance activities to assess the impact
of interventions and adjustment according to results
TYPE OF SURVEILLANCE
Passive: relies on data routinely generated from automated patient records
Active: conducted by train personnel who actively look for evidence that meets standardized
diagnostic criteria of HCAI
Prospective: it monitors pre-selected indicators in hospitalized patients according to a specific
protocol. This is the gold standard
Retrospective: relies on previously recorded routine data after patient discharge and thus many
critical information may be lacking
Infection prevention and control is a clinical and public health specialty based on practical,
evidence-based approach which prevents patients, health workers, and visitors to the healthcare
facilities from being harmed by avoidable infections, including those caused by antimicrobial
resistance pathogens, acquired during the provision of healthcare services (WHO)
COMPONENTS OF IPC
There are 8 core components of effective IPC to be conducted in the country. These include
IPC Programme:
establish a dedicates ipc Programme at national & faculty level with clear objective
responsibilities & trained personnel
IPC guidelines:
implement and update evidence-based IPC guidelines and standard operating procedures
IPC education & training:
Provide regular mandatory training for all healthcare workers with update on IPC
Practice
Healthcare associated infection surveillance:
Monitor all trends call my detect outbreaks early and evaluate the effectiveness of IPC
practices
Multimodal strategies:
a combination of education command reminders, monitoring and feedback, and system
change to improve compliance
Monitoring audit and feedback:
regularly assess IPC practices come up infrastructure and provide feedback to staff and
managers
Workloads staffing and bed occupancy:
optimize human resources command staff to patient ratios and physical space to reduce
infection risk
Build environment materials and equipment:
ensure a clean functional healthcare environment with adequate WASH and waste
management systems
IPC PERSONNEL AND ROLES
IPC personnel are stationed at different levels of the health care system.
Health facility level:
IPC focal person: in charge of IPC measures training and audits
health care workers: follow standard precautions
Hospital administrator or facility manager
Ward/ units coordinators
Support staff
Community level:
Community health workers
Traditional and religious leaders
School health educators
Environmental health officers
Governmental/ national level
National IPC Programme or unit
Policymakers: the integrate IPC international health policies
Surveillance and laboratory team
Training institutions and academia
Regulatory authorities
CHAIN OF INFECTION
Standard precautions
Standard precautions are a set of evidence-based infection prevention practices that are applied
universally to all patients, in all healthcare settings
Social infection prevention and control because
not all infected individuals show apparent signs of infection
They ensure A consistent baseline of protection for everyone
Infectious agents may be transmitted even before clinical symptoms appear
10 WHO STANDARD PRECAUTIONS.
These include
1. Hand hygiene: using an alcohol base scrub or soap & water
2. Use of PPE’s
3. Respiratory hygiene/ cough etiquette
4. Safe injection and medication practices
5. Safe handling of equipment and instruments: properly cleaning disinfecting or sterilizing
reusable patient care equipment
6. Environment cleaning routine disinfecting & cleaning of care areas
7. Waste management
8. Linen handling: handling of soiled Linen carefully to prevent Contamination
9. Prevention of needle stick and sharp injuries
10. Patient placement: for example, coma patient likely to transmit infection in inappropriate
isolation
MODE OF TRANSMISSION
Direct Transmission
Direct Contact:
This refers to the spread of pathogens through direct contact from a reservoir to a susceptible
host
• Skin to skin contact
• STI
• Kissing
• STH such as hookworm
Droplet Spread:
Spray with relatively large, short-range aerosols
• Pertussis
• Meningococcal infection
• Covid
• Common cold
Indirect transmission: the spread of infectious agents from reservoir to a susceptible host via
intermediaries
Airborne transmission
Vehicle
Vectors
CHAIN OF INFECTION
Cleaning protocols
The levels of disinfection include
Low level disinfection
Intermediate level disinfection
High level disinfection
Cleaning protocols
Low level disinfection
• Eliminates most vegetative bacteria, some fungi and some viruses but does not kill
mycobacterium tuberculosis or bacteria spores
• It makes use of questionary ammonium compounds, low concentrator household bleach
and phenols
• It is used in disinfection of non-critical items the contact intact skin and tor routine
environmental cleaning in health care facilities
Intermediate level disinfection
• Eliminate most bacteria including mycobacteria, most viruses and fundi but not bacteria
spore.
• Makes use of high concentration alcohol & higher concentration chlorine compound
iodophore & some phenolics
• Use in disinfecting noncritical & semi critical item & cleaning of surface contaminated
with blood and body fluids
High level disinfection
• Destroys all microorganism accept large number of bacterial spore
• Makes use of glutaraldehyde, ortho-phthalaehyde, hydrogen peroxide, parasitic acid,
chlorine dioxide
• It is used for semi critical items that contact mucous membrane but do not penetrate
sterile tissue
Sterilization
The criteria for determining sterilization requirements include
Intended use or the item:
o invasive procedures sterilization is mandatory
o Contact with mucous membranes high level disinfection or sterilization)
o Contact with intact skin cleaning or disinfection is sufficient)
Material and heat sensitivity
o host stable item (steam sterilization)
o Heat/moisture sensitive Items (ethvlene oxide / hydroden peroxide plasma)\
Risk of infection
Regulatory/ policy standard
Quality assurance for sterilization
o Equipment validation
o Monitoring
o Staff training
o Documentation
o Storage and distribution
o Audits
