Infection Control Vs Microrganisme - PowerPoint Presentation

Slide1

Infection Control Vs Microrganisme

Dr

Rini

Latifah

SpMK

12 Mei 2016

Slide2

Page

2

Normal Flora

Slide3

Slide4

Risk of nosocomial infection

R

eusable containersSingle-use containers

Bacteria

(

%

)Fungi (%)Bacteria (%)Fungi (%)Bacillus sp (89.2)Alternaria sp (2.5)Bacillus sp (8.1)Aspergillus flavus (1.6)Gram-negative rods (25.0) Aspergillus flavus (2.5)Coagulase-negative Staphlococci (6.5)Aspergillus fumigatus (1.6)Micrococcus sp (2.5)Aspergillus fumigatus (2.5) Aspergillus terreus (1.6)Pseudomonas aeruginosa (0.8) Aspergillus glaucus (1.7)  Aspergillus sp (1.6) Pseudomonas sp (1.7)Aspergillus niger (15.0)  Cladosporium sp (1.6)Coagulase-negative Staphylococci (30.8)Aspergillus sp (14.2) Penicillium sp (1.6)Staphylococcus aureus , including MRSA (1.7)Aureobasidium pullulans (2.5)  Alpha-hemolytic Streptococci (23.3)Cladosporium sp (18.3)  Nonhemolytic Streptococci (1.7)Curvularia sp (0.8)   Fusarium sp (2.5)   Penicillium sp (30.8)   Rhodotorula sp (27.5)   Trichoderma sp (5.0)   Ulcladium sp (0.8)   Verticillium sp (0.8)  

.

% = percentage of incoming containers that cultured positive for that microorganism. From Neely et al. 2003

Table shows microorganisms

isolated from incoming infectious waste

containers in the USA

Slide5

Slide6

Slide7

Slide8

Infeksi HAIsHAP-CAPBlood Stream infectionSurgical

S

ite InfectionCAUTI

Slide9

HAP-VAPHospital-Acquired Pneumonia (HAP) : penyakit infeksi parenkim paru yang terjadi ≥ 48 jam setelah dirawat di RS sedangkan pada waktu masuk tidak sedang dalam masa inkubasi infeksi

tersebut

Ventilator-associated pneumonia (VAP) : pneumonia yang muncul setelah 48-72 jam pemasangan selang endotracheal

Slide10

Sumber patogen pada infeksi nososkomial saluran nafas

Udara : Aspergillus

Sumber air : Legionella, P.aeruginosa, A.baumaniiMakanan : batang gram – enterikFomite : S.aureus. Batang gram -Endotracheal tubeNasogastric tubeSuction cathetersBronchoscopeRespiratory devicesH.InfluenzaeS.AureusP.AeruginosaMDR strains

Bennett & Brachman’s Hospital Infection. 2007

Slide11

PATOGENESIS HAP

Mikroaspirasi

 pada pasien yang tidak memakai ventilator : rute utama masuknya bakteri pada saluran nafas bawahPasien sedasi, pasca operasi, abnormalitas menelan  risiko aspirasi lebih tinggiAdanya konsentrasi yang tinggi dari refluks bakteri dari lambung atau infeksi sinus dapat teraspirasi dan meningkatkan level kolonisasi bakteri di orofaringKolonisasi di orofaring merupakan sumber utama masuknya bakteri ke paru serta menjadi saluran dari kolonisasi di lambung

Slide12

Patogenesis VAPPada pasien dengan ventilator, bakteri memasuki saluran nafas bawah melalui rute :

Inhalasi aerosol

Pengembunan di selang yang terkontaminasiKebocoran bakteri dari endotracheal cuffTrauma lokal dan inflamasi dari ETT meningkatkan kolonisasi trakea serta mengurangi clearance organisme dan sekresi dari sal.nafas bawahPembentukan biofilm oleh bakteri pada lumen ETT meningkatkan risiko embolisasi bakteri ke dalam alveoli setelah prosedur suctioning atau bronkoskopi

Slide13

Probable routes of transmission of pathogens leading to VAP

Slide14

Urinary Tract Infection(UTI)

Associated Risk

FactorsA history of previous catheter useDuration the catheter is in situLength of stay in hospital prior to catheter insertionLocation of catheter insertion

Slide15

Associated Risk FactorsA history of previous catheter use

Duration the catheter is

in situLength of stay in hospital prior to catheter insertionLocation of catheter insertion

Slide16

Slide17

Slide18

Slide19

Blood Stream InfectionInfeksi yang terjadi pada hari ke-3/sesudahnya masa perawatan di RS (> 48 jam) dimana terdapat patogen dalam darah yang dikonfirmasi dengan hasil

laboratorium

Faktor resiko yang utama dalam mempangaruhi

infeksi

nosokomial

ini adalah lamanya kateterisasi, level aseptik dan pemeliharaan yang kontinu dari kateter.

Slide20

Blood Stream Infections: Sources of organisms

Slide21

PATOGEN BSI

Sumber : www.cdc.gov/nhsn/forms/57.108_PrimaryBSI

Slide22

Surgical Site Infection

Infection at the site of surgery that occurs within 30 days of surgery if there is no implant (hardware, artificial graft, mesh,

etc) OR occurs within 1 year of the surgery with an implant in placeTypes of SSIs:Superficial incisionalDeep incisionalOrgan or body spaceFrom CDC’s NNIS

Slide23

Factors That may Influence SSI Development

Patient

Age Nutritional status Diabetes Smoking Obesity Coexistent infections at a remote body site Colonization with microorganisms Altered immune response

Length of preoperative stay

Slide24

Factors That may Influence SSI Development

Operation

Duration of surgical scrub Skin antisepsis Preoperative shaving Duration of operation Antimicrobial prophylaxis Operating room ventilation Inadequate sterilization of instruments Foreign material in the surgical site

Surgical drains

Surgical technique

Slide25

Bacterial dose

Virulence

Impaired

host resistance

Risk of Infection

Slide26

Acinetobacter Infections in a Hospital Setting

Ubiquitous:

Widely distributed in nature (soil, water, food, sewage) & the hospital environmentSurvive on moist & dry surfaces32 species>2/3 of Acinetobacter infections are due to A. baumaniiHighly antibiotic resistantNumerous mechanisms of resistance to β

-lactams described in A. baumanii

15 aminoglycoside-modifying enzymes described

Quinolone resistance due to mutations in DNA

gyrase

Slide27

Major infections due to Acinetobacter

Ventilator-associated pneumonia

Urinary tractBloodstream infection infectionSecondary meningitisSkin/wound infectionsEndocarditisCAPD-associated peritonitisVentriculitis

Slide28

Environmental Contamination with Acinetobacter

Bed rails

Bedside tablesVentilatorsInfusion pumpsMattressesPillowsAir humidifersPatient monitorsX-ray view boxesCurtain railsCurtainsEquipment cartsSinksVentilator circuitsFloor mops

Slide29

Acinetobacter Transmission in the Hospital Setting

Direct or indirect contact

Contaminated hands of healthcare workersAirborne transmission via aerosol production (e.g., hydrotherapy) may occurSimor AE et al. Infect Control Hosp Epidemiol 2002;23:261-267.

Slide30

Acinetobacter spp Skin Colonization

Body site

Hospitalized patients (n=40)

Healthy controls (n=40)

Forehead

33%

13%

Ear35%7%Nose33%8%Throat15%0%Axilla33%3%Hand33%20%Groin38%13%Perineum20%3%Toe web

40%

8%

Any site

75%

42.5%

Seifert H et al. J

Clin

Microbiol

1997;

35:2819-2825.

A.

baumanii

isolated from 2 patients & 1 control only

Slide31

31

Opportunistic Fungal Infections

Require

impairment of host immunity

to cause serious infection

Clinical infection -

localized

to severe systemic infectionYeasts:Candida spp. (albicans, tropicalis, parapsilosis, krusei, glabrata, lusitaniae, kefyr, guilliermondii etc.)Cryptococcus neoformansFilamentous fungi: Aspergillus spp. (fumigatus, niger, flavus)Zygomycetes (Rhizopus, Mucor, Rhizomucor, Absidia)Fusarium spp.Penicillium spp. (marneffei)Pseudallescheria boydii (Scedosporium apiospermium)Curvularia spp.

Slide32

32

Predisposing Factors (Immunologic)

Cancer

(esp. hematological malignancy)

Key defect:

Neutropenia

Organ Transplantation

(bone marrow, liver, lung, kidney)Key defect: Neutropenia, Impaired T cell functionCellular Immune Dysfunction (AIDS, lymphoma, CMC)Key defect: Impaired T cell function

Slide33

33

Predisposing Factors

(Non-Immunologic)

Chemotherapy

(cytotoxic) - mucosal damage of GI, respiratory, GU tracts

Antibiotics

- Broad spectrum; loss of normal flora, esp. anaerobic

Invasive devices - breach skin/mucosal defences, i.e. intravenous lines, urinary catheters, tracheostomiesInvasive procedures - surgery, diagnostic biopsies

Slide34

34

Transmission of Opportunistic Fungi

Candida

,

Trichosporon

,

Malassezia

ENDOGENOUSunique straincolonization precedes infectionantibiotic suppression of normal flora, fungal overgrowthEXOGENOUShand carriage health care worker

Slide35

35

Transmission of Opportunistic Fungi

Aspergillus

,

Zygomycetes

, other filamentous fungi,

Cryptococcus

EXOGENOUSinhaled conidiaventilation systems, construction, heliports, plants, environmentdirect contact - dressings, arm boards, burns, wounds

Slide36

Terima Kasih